NUTRITIONAL REHABILITATION CENTRE

DR. VIKRANT KABIR PANTHI

1ST YEAR RESIDENT

DEPARTMENT OF COMMUNITY MEDICINE

NSCB MEDICAL COLLEGE JABALPUR M.P

EMAIL:- vikrantkabirpanthi@yahoo.com

Introduction :-

The Nutrition Rehabilitation Center (NRC) is launched under collaborative scheme of UNICEF and Govt. of India. It is a unit for restoring severely acutely malnourished (SAM) children to good health while educating their mothers about nutrition and child care. The mother is provided with accommodation, food and emotional support as her child is nursed back to health.

When mother and child return to their village, the mother shares her new knowledge with her family and neighbours.

NRC was started in 2005 as an implementation under Integrated Child Development Scheme (ICDS)

NRC are located at PHCs or CHCs

Aim :- To improve the nutritional status of 3rd & 4th grade malnourished children on a sustainable basis

Strategy: - Keep mother & child in NRC for 2‐3 weeks and to train mother in child care & feeding practices

MAJOR FEATURES :

Strength: May vary according to the setup of hospital.

NRC at Jabalpur Medical college is 20 bedded.

Mother or local guardian (Primary care giver) will be accepted with the client.

In case of orphan child, care giver may be hired for supporting the baby for the entire period of stay in the Nutritional Rehabilitation Centre.

In above case honorarium may be paid from RKS ( Rogi Kalyan Samiti) to the Care

giver.

Period of Stay : As recommended by treating Physician & Nutritionist-cum-Counselor.

Usually it is of 14 days.

.

Services to be provided at NRC :

Treatment &Patient management.Nutritional support to inmates. Nutrition education to his/her family

members.Other counseling services viz. Family planning, Better hygiene practices,

Psycho-social care & development.Capacity building of the primary care givers on Preparation of low cost

nutritious diet from locally available food ingredients, Developing Feeding habits & time management in mothers, imparting

knowledge of developing kitchen garden etc.Follow up Services

TYPES OF Nutritional Rehabilitation Centre:-

DAY CARE NRC Similar to crèche or kindergarten Children spends 6-8 hrs daily for 6

days a week in these centers & take 3 meals each day.

Mother may attend centers & help preparation of meals or may attend weekly meeting at the centre

RESIDENTIAL NRC Larger staff and equipments than

day care NRC. Children and their mothers live in

these as inpatients for 14 days or more.

They are more popular and widespread in our country.

NRC

Incentives given at NRC :-

During Stay :-To Mother DA :- 65 Rs./ day X 14 days = 910 Rs.

Transportation charges = 200 Rs.

Total = 1100 Rs.

To AWW who brings the child Rs. 100/-

During Follow Up :-

To Mother Rs. 65. + Rs.200 as transportation charges

To AWW Rs. 100

ADMISSION CRITERIA :-

AGE CRITERIA

Infants < 6 months or < 3 kg being breast fed.

Children between 6 months – 60 months of age

The infant is too weak to suckle effectively independent of his/her Wt. for length ( if this is due to acute illness that has to be treated 1st) ORThe infant is not gaining weight at home (by serial measurement of weight during growth monitoring)

ORPresence of bilateral pitting edema

Wt/ Ht. or Wt/L < -3 Z scores (WHO 2005 Standards) AND/OR

MUAC (Mid Upper Arm Circumference) < 115 mm AND/ORPresence of bilateral pitting edema.

DISCHARGE CRITERIA

AGE CRITERIA

Infants < 6 months or < 3 kg being breast fed

Children between 6 months – 60 months of age

It is clear that he/she is gaining weight on breast milk alone after supplemented suckling technique is being used.

ANDThere is no medical problem (no edema for 7 consecutive days, no infections) ANDThe mother has been adequately trained.

Target wt. gain achieved (i.e. 15% Wt. gain from the Wt. on admission) AND/OR

No Edema for last 7 days in facility based care & for last 14 days in programme AND/ORNo Medical Complications.

ROLES AND RESPONSIBILITIES OF NRC STAFF

Position Roles & responsibilities

ADMO(Med)-cum-Nodal officer

-Over all In -charge of the center. He / She will take day to day administrative decisions regarding the center.

-He will be the drawing and disbursing officer for the center.

Hospital Manager-cum-NRCCoordinator

-He will support ADMO (Med) in managing the Center.

--He / She will coordinate / supervise day to day activities and report to authorities accordingly.

-Coordinate with hospital and other agencies for ensuring essential services.

Nutritionist cum Counsellor - Plan food and nutrition programs and supervise the preparation and serving ofMeals.

-He/She Promotes healthy eating habits and recommends dietary modifications.

-He/She assess patient’s nutritional needs, develop and implement nutrition programs and evaluate and report the results.

-He counsel family members on nutritional practices designed to prevent disease and promote health.

Medical Officers -Attend cases at least once in a day.

-Attend emergency calls as & when required.

Health Worker (F)-Anthropometric measurements.

-Provide treatment under the supervision of the physician.

-Nutritional counselling.

-Attend cases as & when required.

-Help in maintenance of records.

-Willing to work on rotation & at night shift.

Cook -Cook food for inmates.

Attendant -Responsible for housekeeping & maintenance ofcleanliness in the home.

-Help in cooking foods for inmates.

-Develop Kitchen garden in the premises.

SCREENING TRIAGE

APPETITE TEST

Direct admission to Phase 2 in NRC

PASS FAILS

Direct admission to Phase 1 in NRC

Phase 2 Treatment in NRC using F-100 Diet and TF based on proteins and calories recommended in IAP 2006

Phase 1 Inpatient treatment using F-75 diet

Return of apetite or reduction of Edema

Fails appetite test or devlops complications

Transition phase T/t or F-100 Diet

Discharge to follow up by AWW

4 Follow Ups at 15 days interval at NRC

(Done by offering Therapeutic feed )

Ingredients:-

Roasted Groundnut - 1000 gm

Milk powder - 1200 gm

Sugar - 1120 gm

Coconut oil - 600 gm

This feed is used to do appetite test as well as it is given simultaneously with other feeds to child as per the diet plan during his entire stay at NRC.

Therapeutic feed

How to prepare

Take roasted groundnut & grind them in mixer.

Grind sugar separately or with roasted groundnut.

Mix groundnut, sugar, milk powder & coconut oil.

Store them in air tight container.

Prepare only for 1 week to ensure the quality of feed.

Store in refrigerator.

Do the test in a separate quite area.

Explain the procedure of the test to the mother

The mother is made to wash her hands.

The mother sits comfortably with the child on her lap and offers the therapeutic feed.

HOW TO DO THE APPETITE TEST :

BODY WEIGHT POOR MODERATE GOOD

3 - 3.9 <15 15 – 20 >20

4 – 5.9 <20 20 - 25 >25

6 – 8.9 <20 20 – 30 >30

7 – 7.9 <25 25 – 35 >35

8 – 8.9 <30 30 – 40 >40

9 – 9.9 <30 35 – 45 >45

10 – 10.9 <35 35 – 50 >50

12 – 14.9 <40 40 – 60 >60

To pass the Appetite Test the intake of test meal has to be at least in moderate range.

Reference table :- ( Body weight in kg Vs Intake in grams)

F-75 FEEDS

Milk – 28 ml. = ¼ bowl

Sugar – 6.5 gm = 1 ½ teaspoon

Murmura – 3.5 gm. = 2 ½ teaspoon

Veg oil – 2 gm = ½ teaspoon

Energy – 75 Kcal

Protein – 1.2 gm

Lactose – 1 gm

( Given to the child in Phase- 2 treatment)

F- 100 feed

Milk – 90 ml. = 1 bowl

Sugar – 5 gm = 1 teaspoon

Veg oil – 2 gm. = ½ teaspoon

Water to make total vol 100 ml

Energy – 100 Kcal Protein – 2.9 gm Lactose – 3 gm

( Given to the child in Phase- 1 Treatment)

Medicines to be administered at NRC

Vit A :- 6-11 months of age – 1 ml. >12 months of age – 2 ml

Folic acid -5 mg on day 1 & then 1 mg/day on subsequent days at NRC.

Zinc- 2mg/kg/day

Iron- Start on 7th day with 3 mg/kg/day

Potassium (Potklor syrup)- 3-4 mmol/kg/day

Magsulfate [50% w/v]- 0.4- 0.6 mmol/kg/day

Antibiotics:- As per requirements.

Measles vaccine if not vaccinated

A malnourished child before admission to NRC

After treatment at NRC and Follow- ups

Severly malnourished child before admission to NRC

After treatment at NRC and Follow- ups

NRC at NSCB Medical college Jabalpur[ Deptt of Pediatrics]

THANK YOU