The document discusses a study presented on a Nutritional Rehabilitation Centre (NRC) in India. It provides background on malnutrition rates for children under 5 in India and the state of Karnataka. It then describes the services provided at NRCs, including treatment, nutritional support, and education for caregivers. NRCs follow three phases - stabilization, transition, and rehabilitation - to treat severely acutely malnourished children. The study aims to analyze the effects of the NRC in improving child health and evaluate the services and education provided to mothers.

1. NUTRITIONAL REHABILITATION
CENTRE
Presenter- Dr. Gulrukh Hashmi

2. Overview:
1. Need for study
2. Objectives of study
3. Review of literature
4. Materials and methods
5. List of references

3. Need for study:
According to the National Survey (NFHS-3, 2005-06) in India
43 percent children under age of five years are underweight
(low weight for age).
48 percent children under five are stunted (low height for
age).
20 percent children under five years of age are wasted (low
weight for height); Over 6 per cent of these children are
severely wasted (<-3SD). Since ‘wasting’ denotes acute
malnutrition, these children are said to have Severe Acute

6. In Karnataka,
•44% of children under age five are stunted, or too short for their
age, which indicates that they have been undernourished for
some time.
•18% of children are wasted, or too thin for their height, which
may result from inadequate recent food intake or a recent illness.
•38% are underweight, which takes into account both chronic and
acute under nutrition.

7. • Moderate Acute Malnutrition (MAM) is defined by
WHO/UNICEF as:
Weight-for-Height Z-score <-2 but >-3SD of the median
WHO child growth standards.
• Severe Acute Malnutrition (SAM) is defined by
WHO/UNICEF as:
I. MUAC<11.5cm
II. Weight-for-Height Z-score <-3 SD of the median WHO
child growth standards
III. Bilateral pitting oedema
IV. Marasmic-kwashiorkor (both wasting and oedema)

9. Nutritional rehabilitation
centre:
The Nutrition Rehabilitation Center(NRC) has been
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
childcare.

10. Services provided at NRC:
Treatment & Patient management.
Nutritional support to inmates.
Capacity building of the primary care givers on preparation of
low cost nutritious diet from locally available food ingredient,
developing feeding habits & time management in mothers,
imparting knowledge of developing kitchen garden etc

11. Admission criteria
 Children 6-59 months:
Wt/ Ht. or Wt/L<-3Zscores
(WHO 2005 Standards)
AND/OR
MUA C(Mid Upper Arm
Circumference)<115mmAND
/OR
Presence of bilateral pitting
edema.
 Infants < 6 months
• Infant is too weak or feeble
to suckle effectively
(independently of his/her
weight-for-length). OR
• WfL (weight-for-length) <–
3SD (in infants >45 cm).OR
• Visible severe wasting in
infants <45 cm. OR
• Presence of oedema both
feet

12. The principles of management of SAM are based on 3
phases:
Stabilization Phase,
Transition Phase and
Rehabilitative Phase.
1. Stabilization Phase: Children without adequate appetite and/or
major complications are first stabilized and carefully monitored.
This phase lasts for 1-2days. The feeding formula used is F75
which promotes recovery of normal metabolic function and
nutrition-electrolytic balance.

13. 2.Transition Phase: after stabilization phase there is transition phase
lasting for 2-3days to ensure that the child is clinically stable and
can tolerate an increased energy and protein intake. There is
gradual transition from Starter diet to Catch up diet (F 100).The
quantity of Catch up diet given is equal to the quantity of Starter
diet given in stabilization Phase.
3. Rehabilitation Phase: when there is no medical complication and
reasonable appetite this phase starts. It promotes rapid weight gain,
and prepare the child for normal feeding at home

14. F-75 FEEDS F-100 FEEDS
Milk 300ml
Sugar 10gms
Powdered puffed rice
35gms
Veg oil 20ml
Water to make up to
1000ml
Energy 75 Kcal/100ml
Protein 0.9gm/100ml
Milk 900ml
Sugar 75gms
Veg oil 20gms
Water to make
total vol1000ml
Energy100 Kcal/100ml
Protein 2.9 gm/ 100ml

15. Discharge criteria:
Discharge criterion for all infants and children is 15
% weight gain and no signs of illness.
Mother knows how to prepare appropriate foods
and to feed the child.
Follow-up plan is discussed and understood

16. Incentives given:
During stay mother is given 65rs/day and 200rs
as transportation charges.
Anganwadi worker who brings the child receives
100rs
During follow up mother gets 65rs and 200rs
transportation cost
accompanying anganwadi worker gets 100rs.

17. • Many studies have shown that therapeutic feeding
centers and facility based management of SAM is
waste of time and money.
• SAM affected children can be treated with community
based management involving timely detection and
treatment using ready to use therapeutic food and
nutrient dense food at home.
• Even then in India NRCs are still being established.

18. •The National Rural Health Mission (NRHM), Ministry of
Health and Family Welfare facilitates the states in setting
up the NRCs.
•There are total 657 NRCs in India and 15 in Karnataka.
• This study is to analyze the effects of this centre in
improving health of children, evaluate the services given
and to study the effect of health education given to the
mothers/ caretakers

19. THANK YOU