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

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.