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How effective is the integration of facility and community-based management of severe acute malnutrition in India?
B Kumar1, J Shrivastava2, S Satyanarayana3
1Indian Institute of Public Health Delhi, Public Health Foundation of India, New Delhi, India.
Insights
This study on child malnutrition in India found that while nutritional rehabilitation centres (NRCs) improved follow-up visit adherence, achieving and maintaining target weight gain requires further optimization. Older children showed better in-patient care completion.
Area of Science:
- Pediatric Nutrition
- Public Health Interventions
- Malnutrition Management
Background:
- Childhood malnutrition remains a significant public health challenge in developing regions.
- Nutritional Rehabilitation Centres (NRCs) are crucial for managing severe acute malnutrition.
- Evaluating the effectiveness of NRC programs is essential for improving child health outcomes.
Purpose of the Study:
- To assess adherence to in-patient care and follow-up protocols in Indian NRCs.
- To determine the rates of target weight gain attainment and maintenance among children in NRCs.
- To investigate the association between demographic factors and program adherence/outcomes.
Main Methods:
- Retrospective record review of children admitted to two NRCs in Madhya Pradesh, India (2011-2012).
- Analysis of a 74-day program including 14 days inpatient care and subsequent home-based care with four follow-up visits.
- Statistical analysis to evaluate adherence, weight gain, and demographic associations.
Main Results:
- 88% of admitted children completed in-patient care; 76% attended the first three follow-up visits.
- 70% achieved >15% weight gain by the third visit; 77% of those sustained weight gain at the fourth visit.
- Children aged ⩾6 months had significantly higher odds of completing in-patient care (OR 4.5).
Conclusions:
- Combined in-patient and community-based follow-up effectively improved adherence to NRC visits.
- While effective, the program demonstrated a need for enhanced strategies to improve target weight gain attainment and maintenance.
- Age is a significant factor influencing completion of in-patient care in nutritional rehabilitation programs.
Setting:
All children admitted to two nutritional rehabilitation centres (NRCs) during 2011-2012 in Madhya Pradesh, India.
Objective:
To determine 1) adherence to in-patient care and follow-up visits, 2) attainment and maintenance of target weight gain, and 3) association with the children's demographic characteristics.
Design:
A retrospective record review. The 74-day programme included 14 days of in-patient care, with subsequent home-based care and four follow-up visits to the NRC at 15-day intervals. The first three visits were part of the treatment, while the fourth was for assessment of sustained weight gain.
Results:
Of the 1027 children admitted, 900 (88%) completed in-patient care. Of these, 685 (76%) attended the first three follow-up visits, 482 (70%) of whom gained >15% of their admission weight. Of these, 409 (85%) completed four visits, 314 (77%) of whom were able to sustain their weight gain. Those unable to gain >15% weight by the third visit had a significantly lower proportion of sustained weight gain at the fourth visit. Children aged ⩾6 months had significantly higher odds (OR 4.5, 95%CI 3.1-6.2, P < 0.05) of completing in-patient care.
Conclusion:
In-patient care combined with community-based follow-up was effective in adherence to follow-up visits; however, there is still room for improvement in attaining and sustaining the target weight.
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