Severe Acute Malnutrition (SAM) remains a major killer of children under five years of age. Unfortunately, SAM can be seriously life threatening; it can directly cause child death, or indirectly lead to significantly increased risks of case fatality rate in children suffering from common childhood illnesses, such as diarrhoea and pneumonia, writes Elets News Network (ENN).
A Note on MTC
Based on a review of existing studies of case fatality rates in several countries, the W.H.O. has shown that children with severe acute malnutrition face 9-10 times higher risk of death compared to their wellnourished counterparts.
Nutrition Situation in India and Rajasthan
The available information has shown that prevalence of SAM in children is seriously high in India when interpreted as per the World Health Organisation’s (WHO) crisis threshold. Furthermore, there is a concern that the situation has not shown good progress over the last two survey periods (NFHS 3 and NFHS 4). Till late Feb. 2017, the NFHS4 State Fact Sheets have been released for all states and the prevalence of SAM has increased in 18 states, including Rajasthan.
To prevent deaths due to severe acute malnutrition (SAM), specialised treatment and prevention interventions are required. Programmatically, it is helpful to categorise children with SAM into ‘complicated and uncomplicated’ cases based on clinical criteria as:
• Facility/hospital-based care for children with SAM and medical complications.
• Home/community-based care for children with SAM but without medical complications.
Children with SAM, when managed in specialised units with skilled manpower and adequate resources for nutrition rehabilitation have very high levels of survival. SAM is an important preventable and treatable cause of morbidity and mortality in children below five years of age in India.
Malnutrition Treatment Centre (MTC) is a unit in a health facility where children with Severe Acute Malnutrition (SAM) are admitted and managed. Children are admitted as per the defined admission criteria and provided with medical and nutritional therapeutic care. Once discharged from the MTC, the child continues to be in the Nutrition Rehabilitation program till she/he attains the defined discharge criteria from the program (described in National Operational Guidelines for facility-based management of children with Severe Acute Malnutrition, 2011).
In addition to curative care, special focus is given on timely, adequate and appropriate feeding for children; and on improving the skills of mothers and caregivers on complete age appropriate caring and feeding practices. In addition, efforts are made to build the capacity of mothers/caregivers through counselling and support to identify the nutrition and health problems in their child. Besides this a sum of Rs 100/- per day per child admitted in MTC is provided to the parents/ caregivers as wage compositions for the number of days of stay at the MTC.
Objectives of facility-based management of SAM:
• To provide clinical management and reduce mortality among children with severe acute malnutrition, particularly among those with medical complications.
• To promote the physical and psychosocial growth of children with severe acute malnutrition (SAM).
• To build the capacity of mothers and other care givers in appropriate feeding and caring practices for infants and young children.
• To identify the social factors that contributed to the child slipping into severe acute malnutrition. The services and care provided for the in-patient management of SAM children include:
• 24 hours care and monitoring of the child.
• Treatment of medical complications.
• Therapeutic feeding.
• Providing sensory stimulation and emotional care.
Social assessment of the family to identify and address contributing factors.
• Counselling on appropriate feeding, care and hygiene.
• Demonstration and practice- by doing on the preparation of energy dense child foods using locally available, culturally acceptable and affordable food items.
• Follow up of children discharged from the facility.
Currently Rajasthan has 40 Malnutrition Treatment Centres in District Hospitals and Medical Colleges. Thirty six facilities (MTCs) are 10 bedded and 4 are 20 bedded. The total number of children admitted in these MTCs in the financial year 2017-18 was 8104.
Success Story of treatment at MTC:
Reena daughter of Harsh (Names changed), age 4 years was admitted in MTC at Sirohi district hospital on 10 July, 2018 She was from a far of village of Reodar block with complain of loss of appetite and lethargy.
After her anthropometric check-up and biochemical test, she was diagnosed with Severe Acute Malnutrition along with Severe Anemia. Her Hb level was 4.1gm/ dl and therefore she was given ½ unit of blood. F-75 diet was started and gradually as she improved and regained her appetite she was put on F-100 and home-based diet for speedy recovery and weight gain. Her mother was also taught about how to prepare and feed the child after discharge. By the time of discharge Reena (Name changed) had gained 2.5 KG and her weight became 10.120 KG from 7.545 KG.
Her parents were very happy to see the recovery of their child and said that they will now take proper care of their daughter as they were taught to do during their stay in MTC and tell in their village about the facilities that are provided to ‘Kamzor’ SAM children in MTC and will get Reena for timely follow up visits to the hospital.
Success Story 2:
One-year old Kamal (Name changed) who lives in Pasuniya village of Nathadwara block, Rajsamand District was brought to OPD at RNT Medical College, Udaipur with the complaint of severe diarrhoea, vomiting and fever. In the village, he was first taken to Bhopaji (spiritual man) for treatment, it was the same place where Kamal got his belly marked (daam) to keep away evil spirits when he was six months of age. After taking offerings of chicken, wine bottle, coconuts and money from the family the bhopaji tried to treat Kamal with his rituals called jhada, but to his dismay Kamal was not able to revive and surprisingly the bhopaji himself advised the family to take the child to the hospital. The child was brought in a serious condition to the emergency at 10 pm after travelling a distance of 57 km by local bus.
Kamal was breathing fast had fever and cough. He was immediately taken care of at the hospital. He was given glucose and fluids through IV as he had diarrhoea with lethargy and slow skin pinch as danger signs. Blood was drawn for glucose, malaria and hb tests. After screening for infections and taking anthropometric measurements, Kamal was sent to MTC where he was taken care of by the trained staff of the ward. Here he was kept warm covered in a blanket, close to his mother and after the first few hours he was shifted to F-75 therapeutic feed with antibiotic treatment. Later vitamins and minerals were also added in the therapy to build up his immune system and also make up for the electrolyte loss due to diarrhoea and vomiting.
The child started recovering and slowly gained some weight from 3.05 KG at the time of admission to 3.35 KG on the 13th day. His mother is very happy with his progress in the MTC. Nainu (Kamal’s mother) is a young girl of 16 years of age married for past 4 years. Kamal is her 1st child and was born at the same hospital. She was given advice for exclusive breastfeeding during her discharge, which she followed till six months but thereafter due to lack of information regarding complementary feeding she was not able to feed her baby according to the requirements for his growth, which led to deterioration in his health.
Kamal a low birth baby of 1.20 KG received only the initial immunization in the hospital (BCG, OPV and DPT). Faulty feeding practices and lack of proper immunization led to repeated infections causing incidence of diarrhoea and vomiting in the child. It is a common practices in the Scheduled Tribes of the state to get their girls married at a young age leading to early pregnancy and child birth at a young age. The mother’s weight in this case was 32 KG and she herself was undernourished. But Nainu’s attachment with her child and the will to learn more about child rearing practices started showing in the improved health of Kamlesh. She stayed at the MTC for more than 10 days and not only learnt the skills of feeding and caring taught to her by the doctors and paramedics at the MTC but also communicated the same to the other women in the community.