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Declining Child Malnutrition in Maharashtra-5 The Rehab efforts
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Declining Child Malnutrition in Maharashtra-5 The Rehab efforts

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There is about 4-5 % severe acute malnutrition-SAM-in tribal parts of Maharashtra. Rehab is necessary. Rehab efforts are available from village Anganwadi level to the block level CTC and the district …

There is about 4-5 % severe acute malnutrition-SAM-in tribal parts of Maharashtra. Rehab is necessary. Rehab efforts are available from village Anganwadi level to the block level CTC and the district hospital NRC.

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  • 1. Child Malnutrition in Maharashtra (India) August 2013- January 2014 2013- Situation, Efforts, Decline and Challenges A Review For the State Nutrition Mission PowerPoint5/6 Nutrition Rehab for SAM MAM babies Dr Shyam Ashtekar, MD (Community Med) shyamashtekar@yahoo.comnganwadi-supplementary feed--Dr Shyam A ashtekar jan 2014 1
  • 2. PowerPoint 5/6 NUTRITIONAL REHAB EFFORTS IN MAHARASHTRA FOR SAM MAM BABIES DR SHYAM ASHTEKAR 2014 Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 2
  • 3. NUTRITIONAL REHAB LEVELS NRC at District Hospital 2 wk CDC at Health Center or Hospital 3wk Village level Child Development Center (VCDC) 4 wk Home levelRehab Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 3
  • 4. A display of Malnutrition data in AWC Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 4
  • 5. SAM & MAM-Recent Malnutrition MAMSAM (severe acute malnutrition) –is wasting below -3SD, also severely low MUAC (red zone)— SAM needs rehab, for risk of child death. MAM is moderate acute malnutrition, below -2SD (but above -3SD) of wasting or MUAC yellow zone. MAM babies are usually not for rehab centers.. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 5
  • 6. Criteria for SAM-MAM Nutritional rehab SAM(1) Wasting is defined as underweight for that height. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 6
  • 7. Criteria for Nutritional rehab (2) MUAC >11.5 cm. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 7
  • 8. Criteria for Nutritional rehab (3)Foot Edema Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 8
  • 9. Why not use the Underweight for Age Test? Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 9
  • 10. Nutritional Rehabilitation of MN Children Soon after diagnosis we need to start rehab efforts. Moderate MN children can be managed at home or AWC with some treatment and special nutrition But severe MN child needs help at NRC Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 10
  • 11. Nutritional Rehab Appetite must improve first, this takes about one week. Weight gain comes after that. Rehab may take 3-4 weeks. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 11
  • 12. (1) Village Child Development Center This is held in AWC 2-3 times in the year as per need. Each camp takes 4 weeks. Time is 9 to 4pm, with 12 to 2 pm. recess. Initial treatment for infection is important. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 12
  • 13. Village Child Development Center Feeds are given in AWC from 9 to 12pm and 2 to 4 pm. Various food items are given using THR, milk powder. The AWC meal of that day, banana, roasted potato etc. The mother feeds between 12 to 2 pm at home. Occasionally eggs are served. All this is expected to improve the child’s status. Not enough provision to meet the requirements Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 13
  • 14. Village Child Development Center (VCDC) In Some blocks they offer special feed prepared from groundnut flour, oil, milk powder and sugar mixed together as a semi-solid meal. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 14
  • 15. Special Amylase feeds Amylase develops in sprouting grain & legumes Amylase helps digestion. For this wheat and green gram which are sprouted, dried and powdered. This flour mixed with groundnut flour, oil, Sugar & makes a good paste for the child, most children like this. Micronutrient sachet is added to this once daily. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 15
  • 16. Use of Medicines Albendazol is used for curing worms. Amoxicillin is used for controlling infections. Some Ayurvedic medicines like Shilajit Iron Folic Acid syrup Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 16
  • 17. Home VCDC Sometimes a rehab camp is difficult to organize, due to constraints, or too few children that need help. Home VCDC is a better option and costs much less. Provisions come from AWC including the THR Packs. The AWC Sevika attends 1-2 times daily to home visits. Akola and Nagar district used this option for rehab. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 17
  • 18. Home VCDC Info Sheet in Akola Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 18
  • 19. Home VCDC Info Sheet Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 19
  • 20. (2) Child Treatment Center (CTC) Children who did not need admission to CTC The CTC is held suitably in a Primary Health Center or Rural Hospital, whenever necessary. Mothers stay there with their child for 3 weeks The mother is given Rs. 150/- as lost wages. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 20
  • 21. CTC in Jawhar block. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 21
  • 22. …CTC Medical and nutrition therapy is given here under medical supervision. The special feed is prepared from milk, groundnut flour, oil and sugar in liquid form. This feed is given 8-9 times every day till the child sleeps at night. The feed may be prepared 3-4 times a day depending on weather (hot weather spoils the food). Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 22
  • 23. CTC in Jawhar We saw about 30 children admitted in CTC in August 2013. Most children loose weight in the first week due to reduction of oedema. Weight gain starts generally in next week as appetite grows. With better appetite a thicker formula feed is used. (F 100) Gradually liquid diet is replaced with semi solid feeds. But the risk of malnutrition at home is still there. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 23
  • 24. (3) District NRC Nandurbar Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 24
  • 25. District NRC Nandurbar Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 25
  • 26. District NRC Nandurbar Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 26
  • 27. The infanto-meter for height infantomeasurement in the NRC Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 27
  • 28. The NRC The NRC is established at district or block hospital round the year. The usual period for stay is 2 weeks The NRC ward has 20-30 beds The NRC has child specialist, nutritionist and nurses and other staff The special feeds are same as in the CTC But more investigations and medicines can be employed in the NRC At discharge the child follow up arrangements are made. NRC is an essential support for tribal districts. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 28
  • 29. The Benefits of Nutritional Rehab Rehab arrests further damage to malnourished children Many children improve, some dont. Rehab facility is necessary to prevent avoidable child deaths. Not all parents are wiling to admit their children in the facility Lost wages are given, but there are some other chores at home..which make some parents helpless Not all parents are equally concerned about the sick child, some do leave against medical advice. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 29
  • 30. The Special Feed Formula Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 30
  • 31. NICU (Neonatal Intensive Care Unit) Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 31
  • 32. NICU NICU admits neonates (under 1 month). The babies are either premature, very low birth weight or sick. These babies need special care. NICU offers warmth and ultraviolet therapy. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 32
  • 33. Surgical Treatment for Seriously Ill Babies Some babies look wasted/non thriving because of serious illnesses like congenital heart diseases This calls for complicated surgeries and care—only available at some centers. Hundreds of children got this care in the last two years. There is Govt assistance for this, esp. the Jeevandayi Yojna. This has created a better rapport of the ICDS system with families and people. Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 33
  • 34. शभे छा ु Dr Shyam Ashtekar (MD, Community Medicine) 21 Cherry Hills Society, Anandwalli, Nashik 422013 shyamashtekar@yahoo.com Cell +919422271544 Website: arogyavidya.org, bharatswasthya.net A study of Anganwadis and campaign against malnutrition in Maharashtra for and with support of Rajmata Jijau Mission, August to Dec 2013 Nutritional Rehab Efforts in Maharashtra-Dr Shyam Ashtekar Jan 2014 34