Growth Prospects of Children after Discharge from Malnutrition Treatment

Centers: Study from Jharkhand, IndiaAnuraag Chaturvedi and Jyoti Sharma

Pubic Health Foundation of India

Background

• Govt. of India introduced the facility based care of SAM under National Health Mission in 2006.

• High mortality, persistent stunting, inadequate weight gain, frequent infections and poor diet intake remain issue among children discharged from MTCs.

Objective

• Present study measured the growth and nutritional outcomes of children after discharge from MTCs in order to identify the risk factors that have implications on the health and nutritional status of children in the post rehabilitation period of SAM episode.

Methods

• This was a cross sectional study wherein nutritional assessment of children was done who were discharged from 14 selected malnutrition treatment centres.

• The children discharged at three different point were included in the study to capture the programme outcomes at the different time intervals

• Height, weight and mid upper arm circumference of children were measured using standard methods.

• Dietary intake of children was measured using food frequency and 24 hours dietary recall.

• Episodes of morbidities and access to health and nutrition services after discharge was assessed by reviewing medical records or interviewing mothers/ care takers.

Time interval since discharge- 3 months

Time interval since discharge- 6

monthsTime interval since discharge- 9

months

Assessment of

children-Feb 2012MTC operating

before Mar 2011

Cohort

discharged in

Apr-May ,2011

Cohort

discharged in

July-Aug,2011

Cohort

discharged in

Oct-Nov,2011

Background Characteristic Group A (n=50)

3 months since

discharge

Group B (n=49)

6 months since

discharge

Group C (n=51)

9 months since

discharge

Total (150)

Sex of children

Male 62 (41.3)

Female 88 (58.7)

Age of child (in months)

6-11 6 (12.0) 2 (4.1) 0 (0.0) 8 (5.3)

12-23 35 (70.0) 28 (57.1) 19 (37.3) 82 (54.7)

24-35 6 (12.0) 14 (28.6) 25 (49.0) 45 (30.0)

36+ 3 (6.0) 5 (10.2) 7 (13.7) 15 (10.0)

Profile of children

Housing conditions

Protected source of drinking water 34 (68.0) 42 (85.7) 35 (68.6) 111 (74.0)

Toilet (home or community) 2 (4.0) 0 (0.0) 1(2.0) 3 (2.0)

Open space or field 48 (96.0) 49 (100.0) 50 (98.0) 147 (98.0)

Mother’s education

No schooling 34 (69.4) 34 (70.8) 38 (77.6) 106 (72.6)

1-8 9 (18.4) 8 (16.7) 8 (16.3) 25 (17.1)

9+ 6 (12.2) 6 (12.5) 3 (6.1) 15 (10.3)

Anthropometric indices after discharge

Wasting - Weight for Height z scores ( WHZ) Underweight -Weight for Age z scores ( WAZ)

Calorie and Protein Gap and Malnutrition

Distribution of morbidities in children in last 3 months

Follow-up visits to MTC

Proportion of children visited MTC after discharge

Reasons for visit defaults

Number

of visits

Group

A

(N-50)

Group

B

(N-49)

Group

C

(N-51)

Total

(N-

150)

None 44.0 55.1 35.3 44.7

Only one

visit

16.0 8.2 21.6 15.3

Only two

visits

10.0 8.2 19.6 12.7

All three

visits

30.0 28.6 23.5 27.3

Amount of Supplementary food received as Take Home Ration (THR) in grams

50-199gm11%

200-374gm60%

375+gm12%

Not received

17%

Pulse

<250gm10%

250-949gm38%950+gm

35%

Not received

17%

Soyabean

Mean availability of ration to children after intra household distribution

Ration

type

Ration

size/day

Ration

received/day

Ration

shared

Ration available for child

Mean

(gms)

Percentage

Rice 60 grams 45 grams (75 %) 32.2

grams

12.8 28

Daal 15 grams 10.6 grams

(71%)

7.7 grams 2.9 grams 27.3

Soyabean 10 grams 8 grams (80%) 5.6 grams 2.4 grams 30

Sugar 38 grams 10 grams (27%) 7.3 grams 2.7 grams 27

Oil 5 grams 4.5 (90%) 3 grams 1.5 grams 33

Results • High relapse to severe malnutrition was observed in all three groups of children.

About 42.7% of children were severely wasted at the time of survey.

• More male children (51.6 %) were found to be wasted compared to female children (48.4 %).

• The decline was found to be steepest in group A children followed by children from group B.

• Multiple morbidities were common, respiratory infection reported as most common illness, followed by episodes of diarrohea and fever.

• Diet of children was found deficient in almost all essential nutrient including protein and calorie. Calorie gap was wider among older children

• 44.7% children never visited MTC even once after their discharge.

• Take home ration received from ICDS used as a family pot, about 70 % of the received ration gets shared among family members leaving only 1/3rd of ration for the targeted children.

Conclusion

• Results highlight high relapse to severe malnutrition among children discharge from MTCs.

• Poor dietary intake and frequent morbidities reflect continued poor child care practices in the community.

• Counselling provided at MTC not translated in to practice

• Community based management of children after discharge need to be made more robust along with strong follow-up and BCC strategy.