DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20161046

Experience in managing children with severe acute malnutrition in nutrition rehabilitation centre of tertiary level facility, Delhi, India

Alka Mathur, Geetanjali Tahilramani, Dinesh Yadav, Veena Devgan

Abstract


Background: As per NFHS-3 approximately 8.1 million children under the age of 5 years (6.4%) suffer from severe acute malnutrition (SAM). To assess the potential of addressing SAM with complications effectively at a Tertiary level Hospital following facility based guidelines of Government of India (GOI) for Severe Acute Malnutrition and to analyse the co-morbidities associated in these children.

Methods: This study was carried out in nutrition rehabilitation centre (NRC) of Hindu Rao Hospital (HRH), New Delhi India. For this review of data of SAM Children who were transferred to NRC & who stayed for 7 days or more in the hospital during 1st August 2012 to 30th November 2014 was done. Intervention involved detection and treatment of SAM children adopting GOI, 2011 guidelines. Assessment & interpretation of survival, co-morbidities and recovery rates was done.

Results: After screening of 5295 (2-59 months) children admitted during above mentioned period, 906 (17.1%) were found to be having associated SAM. Out of 906 SAM patients 473 (app 52%) were shifted to NRC after initial stabilization. Children who stayed for 7 days or more were 327 (69.1% of transferred cases), their data was analysed. Of these 47.8% (n-156) children had diarrhoea/dysentery as the presenting complaint and 37.5 % (n-122) had pneumonia or other respiratory infections. Other Co-morbidities were severe anaemia, tuberculosis, meningitis, UTI, etc. Urine culture was positive in 17% cases (n-19 out of 112 cases in which urine culture could be sent). There were 88 % (n-272) anaemic children, 42.5 % (n-141) were having moderate anaemia (7-9.9 gm/dl) and 20.1% (n-65) were having severe anaemia (< 7.0 gm/dl). Packed cell transfusion was given to 9.6% (n-31) children. X-ray wrist was suggestive of Rickets in 39.2% (n-121) cases. Two children were positive for HIV. App 76% children had moderate (5-9.9 gm/kg/day) to good weight gain (10 gm/kg/day or more). Children more than 24 months old had significantly higher weight gain (41% vs. 34%). 39% Male children had good weight gain as compared to 32 % in females. Average weight gain of the NRC was 8.5 gm/kg/day. Only 18.2% children were registered under Aanganwadi. For 38.7% Nutritional status was not their priority even after repeated counselling and they preferred to leave early. Other reasons were like commitment for other family members (34.3%), siblings (24.4%) and job of mother (2.5%). Mortality was only 1.8 % (17 out of 906) of all admitted SAM children during this period, and no mortality in NRC ward.

Conclusions:It is practical and effective to manage complicated SAM as per GOI guidelines, in a hospital setting with NRC attached with pediatrics department.


Keywords


NRC, SAM, Severe wasting, Co-morbidities, Urinary Tract Infection, Anaemia, MUAC, WHZ

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References


National Family Health (NFSH-3) India Survey 2005-06. Available from: http://www.rchiips.org/ NFHS/index.shtml. Accessed : 10.01.2015

WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children. A joint statement by WHO and UNICEF, 2009. Available from: http://www ho.int/nutrition/publications/severe malnutrition/ 9789241598163_eng.pdf. Accessed: 22.12.2014.

Bhatnagar S, Lodha R, Choudhury P, Sachdev HPS, Shah N, Narayan S. Guidelines 2006 on Hospital Based Management of Severely Malnourished Children (Adapted from the WHO guidelines), Indian Paediatr. 2007;44:443-61.

Facility Based Care of Severe Acute Malnutrition (SAM), Participant manual. 2011.

World Health Organization, Technical report series No.45, Nutritional anaemia Report of a WHO scientific group, Available from: http://whqlibdoc.who.int/trs/WHO_TRS_405.pdf. Accessed at: 05.03.2015

Operational Guidelines on Facility Based Management of Children with Severe Acute Malnutrition, Ministry of Health and Family Welfare, Government of India. 2011.

Guideline updates on management of severe acute malnutrition in infants & children, WHO. 2013. Available from: www.who.int/iris/bitstream/ 10665/95584/1/9789241506328_eng.pd.Accessed:20.01.2015 (Page No 14)

Singh K, Badgaiyan N, Ranjan A, Dixit HO, Kaushik SA, Kushwaha KP, et al. Management of Children with Severe Acute Malnutrition: Experience of Nutrition Rehabilitation Centre in Uttar Pradesh. Indian Paediatr. 2014;51:21-5.

Kumar R, Singh J, Joshi K, Singh HP, Bijesh S. Co-morbidities in Hospitalized Children with Severe Acute Malnutrition. Indian Paediatr. 2014;51:125-7.

Talbert A, Thuo N, Karisa J, Chesaro C, Ohuma E, Ignas J, et al. Diarrhoea Complicating Severe Acute Malnutrition in Kenyan Children: A Prospective Descriptive Study of Risk Factors and Outcome. PLoS ONE. 2012;7(6):e38321.

Abel HI, Mwate M, Veronica M. Diarrhoea is a Major killer of Children with Severe Acute Malnutrition Admitted to Inpatient Set-up in Lusaka, Zambia. Available from: http://www.nutritionj.com/content/10/1/110. Accessed:02.02.2015.

Page LA, Rekeneir ND, Sayadi S, Aberrane S, Janssens AC, Rieux C, et al. Infections in Children Admitted with Complicated Severe Acute Malnutrition in Niger.Available from; PLoS ONE 8(7):e68699. Accessed at: 18.02.2015.

Kelsey DJJ, Berkley JA. Severe acute malnutrition and infection Paediatrics and International Child Health. 2014;34:S1-29.

Thakur N, Chandra J, Pemde H, Singh V. Anaemia in severe acute malnutrition. Available from: http://www.nutritionjrnl.com/article/S0899-9007(13)00443-7/pdf, http://www.ncbi.nlm.nih.gov/ pubmed/24332525.Accessed : 20.02.2015

Mamidi RS, Kulkarni B, Radhakrishna KV, Shatrugana V. Hospital Based Nutrition Rehabilitation of Severely Undernourished Children Using Energy Dense Local Foods Indian Paediatr. 2010;47:687-93.