Abstract

The childhood undernutrition is an important public health and development challenge in developing countries including India. Despite multiple National Nutrition Programs implemented over last 50 years and supplementary feeding activity as a nutrition improving activity in Integrated Child Development Scheme since 1975, it is matter of concern that we still run nutrition rehabilitation centers for hospitalizing and managing Severe Acute Malnutrition (SAM) cases coming from poor-socio-economic families even in 2021. COVID-19 pandemic since early 2020 has further exacerbated the situation with shrinking food diversity and low intake combined with episodes of missing supplementary feeding at times. Over a million Anganwadi centres have identified nearly a million ‘severely acute malnourished’ children from six months to six years across the country as of November 2020. The recently published results of Phase I of the National Family Health Survey-5 have reported an increase in the incidence of SAM over the last 10 years.
Nutrition Rehabilitation Centres (NRCs) launched in 2014 as National Plan of Action for Children were meant to treat SAM cases at health facilities. However, there are studies that suggest that NRCs have not been highly effective. In many NRCs, SAM cases are being discharged early because either the caregivers could not stay for a requisite duration, or the centre could not keep the baby for requisite period, due to lack of oversight.
We report one such SAM case and its management in NRC, that was discharged without fulfilling the NHM criteria. One year and 5-month-old female baby was brought to Pediatric OPD, on 9/4/2021, with a complaint of 15 days of fever, progressing from mild grade to high grade, and loss of appetites, and a history of vomiting soon after feeds and fatigue for last 1 week to the District Hospital, Gadag, Karnataka, India. The baby weighing 7kg as against expected weight of 9.1kg for her age was shifted to Nutrition Rehabilitation Centre (NRC) and managed for 14 days as per NHM guidelines. She was put on Vitamin B12 injection 1000 mcg daily for seven days, Amoxiclav (Amoxicillin) injection 200mg morning and evening for 7 days, Paracetamol injection 100 mg morning and evening. Apart from the injections she was given oral drugs vitamins and minerals that included tablet folic acid 5 mg once a day for 14 days, Multi vitamin syrup 2.5ml, calcium syrup 5ml morning and evening, syrup of zinc 5ml morning one time for 14 days. Key nutritional therapy included
a) F-75, 75ml every 2 hour on the first day,
b) Second day 110 ml of F-75 3 hourly and
c) 145ml -4th hourly on day 3.
d) Fourth and fifth day catch up diet of F-100 150 ml along with the foods and
e) another 2 days 250ml of F- 75 was given and continued for 14 days.
After 14 days patient’s condition improved, she was active and taking adequate food, but had gained only 400G of weight and did not meet criteria for discharge. This proves the need to strengthen and monitor the outcomes of NRC’s even in 2021-30 decade to achieve SDG pertaining to nutrition and country.

Keywords: SAM; NRC; Infection & nutrition therapy; Empowering for feeding at home