A FIELD VISIT OF STABILIZATION CENTRE

JAMSHORO
SATURDAY 18TH DECEMBER

INTRODUCTION:
Study field visit aranged by SZABIST for the students of master of
science in publichealth
Only for the CMAM group,purpose of the visit was to observe
Stablization Unit where
Severely malnourished children were admitted and treated till recover
gain some weight.
Stabilization centers are developed for malnourished children. It is an
in- patient facility. The CMAM Program.
CMAM Program is running in all over world for the malnourished
children espacially focused in underdeveloped countries estimated
about 70 (seventy) countries, for malnourished children.

Malnutrition is a major issue for women and children, especially in

rural areas of Pakistan. ... Food insecurity, maternal
undernutrition, disease and illness, inadequate health services
and lack of awareness about feeding and healthcare practices are
the main reasons for malnutrition in children.
Pakistan has been reported to have one of the highest levels of
prevalence of child malnutrition compared to other developing
counties .
According to the National Nutrition Survey, 33%of all children
were underweight, nearly 44% were stunted, 15% are wasted,
50%were anemic, and 33%were anemic (iron deficiency).04-May-
2018

Pakistan's CMAM programme encompasses three components:

(a) early detection of children with SAM through
community outreach and active case finding to maximize
coverage and impact; (b) inpatient therapeutic care in a
stabilization centre (SC) for children with medically complicated
SAM; and (c) outpatient therapeutic
The CMAM approach aids to create long-term. community-based
therapeutic care programme, decentralizes malnutrition care and
treatment, increases. the coverage and ensures that timely and
appropriate care. is easily accessible to all malnourished children
residing.
Stabilisation centres (SC) provide in-patient care for acutely
malnourished children with medical complications. These children
are at high risk of death and will receive treatment for their
medical complications until their condition is stabilised, usually a
5- to 7-day period.
Many nutritional programmes (eg, School Health Programme,
Micronutrient Initiative, National Programme for Family
Planning and Primary Health Care, and Tawana Pakistan
Project) have been initiated by governmental and
nongovernmental organisations,
 Considering the situation,Government of sindh launched the
Nutrition Support Program(NSP)with financial support of World
Bank(WB)through planning commission(PC 1).The program was
launched in nine districts of sindh i.e
Larkana,Qamber,Kashmore,Jacobabad,TandoMuhammad
khan,Badin,Sanghar,Umerkot and Tharparkar.in march 201,PPHI
Sindh signed an MOU with NSP to initiate the field activities.the
initial agreement was of 30 months till september2018 which is
further extended for 13 months till december2019.under
NSP,PPHI Sindh established OPT nutritional clinic where
management of severe Acute Malnutrition(SAM)is done
sites,provided treatment of SAM children with ready to use
therapeutic(RUTF)and nutrition
Specific sessions to the communities.under NSP,PPHI Sindh
established 270 OPT sites in thePPHI Sindh managed health
facilities in two fifty six union councils of nine districts of sindh.till
October,2018 project has successfully cured 87percent SAM
children with only 4.9 percent default rate.Apart from SAM case
management,43,998 health and nutrition sensitive sessions and
40,338 sessions of IYCF(Infant & young child feeding)conducted
reaching 819,327 people.
Considering moreserious problem in Umerkot and
Tharparkar,United Nations World Food Program(UNWFP)also
started its interventions to manage the Moderate Acute
Malnutrition(MAM)in under five years old children and pregnant
and lactating women(PLW)the WFP interventions have been
intermittent and are limitted to management of MAM.
PPHI Sindh’s nutrition program providesnutritional services to
most susceptible community in21 districts of sindh.
Stabilization centers for acute malnourished children with
complication, complication like bilateral pitting edema +++,
dehydration, and any systemic disease. These patients are admitted in
stabilization centers through OTP (out-patient therapeutic program),
and through house to house visit of lady health workers or male
health workers. In Stabilization centers designed treatment of CMAM
by F-75, F-100 and RUTF.
We were welcomed at LUHMS by PPHI Jamshoro team along with
project director nutrion
Program, he brief us about program and stablization centre,
Then we visited stablization unit with program manager and their
clinical team
Was also there,

Stabilization centre,
1. A very neat and clean atmosphere was maintained with proper
IP protocols
2. There are 14 (fourteen) bedded facility. Two wards, one is
general ward, which contain 10 (beds) and second one is HDU
(High Dependency Unit), which contain 4(four beds). Serious
patients are treated at High Dependency Unit.
3. Kitchen (are also decorated and full of accessories which need
for making food and store food or milk. For example: burner for
making food and milk and refrigerator for storing milk and food
and jug and glasses etc.)
4. Doctor room or medical officer room.
5. Store room (Shelves are there, where nutritional stock or
inventory and stationary are)
6. Examination room, which is within doctor’s room. (That was fully
equipped details are below, equipment also present at general
ward).
7. Play room (for children where they play).
8. Lobby (for mothers, where there is television, and mothers take
rest and watch television. They use television as a tool of
 messaging, where key messages and importance of breast
feeding run).
9. Trained staff (Staff were well trained and skilled. This is due to
they have spent many years in pediatric ward and frequently
trainings).

Available Equipments

1. WEIGHING MACHINE
2. HEIGHT SCALE
3. MUAC (MID UPPER ARM CIRCUMFERENCE).
4. STETHO SCOPE
5. BLOOD PRESSURE APPRATUS
6. THERMOMETER (DIGITAL).
7. ALSO THOSE WHICH ARE NEED IN SYSTEMIC
EXAMINATION.
Routine Medication for SC admissions
The next page presents a summary of the routine medication to
be given to ALL children admitted directly into OTP and to SC,
even if they do not present clinical signs of infection. Children
transferred from one centre to another while undergoing
treatment have already received their routine medications, and
do not need to receive them again. Medications are given as a
single-dose treatment so that the health worker can observe
administration and avoid problems with compliance. The one
exception is the first-line antibiotic (Amoxycillin): the first dose
 should be given in front of the health worker who explains to the
carer how to continue treatment at home.
Vitamin A Give ONLY to wasted patients. DO NOT give on
admission to patients with oedema. Check if the child has already
received Vitamin A during a vaccination campaign or a health day
in the last three months. In this case, do not give Vitamin A again,
to avoid overdose. Vitamin A deficiency in Somalia is very
prevalent. The amounts of Vitamin. A in RUTF are enough to
manage mild deficiencies, but not to treat a child with important
Vitamin A deficiency. Vitamin A can be given as well at the 4th
week of treatment, including those that have been transferred
from Inpatient care and those that did not receive it on admission
because they had oedema.
Antibiotic Most severely malnourished children have several
infections, but they cannot be diagnosed due to diminished
inflammatory response (which hides the signs of infection). Treat
all children admitted to the OTP. First line choice is Amoxycillin for
7 days, as it is effective against small bowel overgrowth, usually
associated with malnutrition. See below for dosages based on
child’s weight. If a child is receiving Cotrimoxazole prophylaxis due
to a chronic disease, this should continue at the same dose
throughout the duration of treatment. You still need to give the
Amoxycillin to these children.
Malaria treatment First line treatment in Somalia is with
Artesonate (3 day) and Sulphadoxine Pyrimethamine(1 day). See
the table below for dosages based in child’s weight. Malaria
treatment is give treatment if a rapid diagnostic check and/or
microscopy is positive or the child has clinical signs (particularly if
fever persists after completing antibiotics),
 Measles vaccination Standard treatment includes measles
vaccination to all children admitted to OTP. Measles vaccination is
not usually done in Somalia, due to lack of cold chain in many
centres, except in the presence of a measles epidemic. As soon as
your centre is equipped with a cold chain, start vaccinating all
children admitted to OTP.
De-worming Albendazole is the only routine medicine that is
given only on the second visit of the child and only for children
above 1 year. In case of doubt on age, give only to children who
can walk. In some programmes, Albendazole can be replaced with
Mebendazole (but check dosages: they are different).
Iron and Folic Acid Not to be given routinely, since there is
enough in RUTF. Where anaemia is identified, treatment should
begin after 14 days of care and NEVER before, following standard
guidelines. For severe anaemia, refer to inpatient care.
Other nutrients RUTF already contains all the other nutrients
required to treat the malnourished child. Additional potassium,
magnesium or zinc should not be given – even if they present
diarrhoea! -, as far as the child takes the RUTF, as an additional
micronutrients may cause excesses.
DR:SABHAGI MEMON
20104112
MSPH 36 3 A