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

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

Period of Stay :

y As recommended by treating Physician & Nutritionist-cum-Counselor. y Usually it is of 14 days.

.

SERVICES TO BE PROVIDED AT NRC :
y Treatment &Patient management. y Nutritional support to inmates. Nutrition education to his/her family y y y y

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 O

TRITIO AL REHA ILITATIO CENTRE:NRC

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.

INCENTIVES GIVEN AT NRC :During Stay :To Mother DA :- 65 Rs./ day X 14 days = 910 Rs. Transportation charges Total To AWW who brings the child = 200 Rs. = 1100 Rs. Rs. 100/-

During Follow Up :To Mother To AWW Rs. 65. + Rs.200 as transportation charges Rs. 100

ADMISSION CRITERIA :AGE
Infants < 6 months or < 3 kg being breast fed.

CRITERIA
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) OR The infant is not gaining weight at home (by serial measurement of weight during growth monitoring) OR Presence of bilateral pitting edema

Children between 6 months ± 60 months of age

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

MUAC (Mid Upper Arm Circumference) < 115 mm
AND/OR

Presence of bilateral pitting edema.

DISCHARGE CRITERIA
AGE CRITERIA

Infants < 6 months or It is clear that he/she is gaining weight on breast milk alone after < 3 kg being breast fed supplemented suckling technique is being used. AND There is no medical problem (no edema for 7 consecutive days, no infections) AND The mother has been adequately trained.

Children between 6 months 60 months of age

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/OR No Medical Complications.

ROLES AND RESPONSIBILITIES OF NRC STAFF
Position
ADMO(Med)-cum-Nodal officer

Roles & responsibilities
-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-NRC Coordinator

-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 of Meals. -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.

-Anthropometric measurements. Health Worker (F) -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 of cleanliness in the home. -Help in cooking foods for inmates. -Develop Kitchen garden in the premises.

(Done by offering Therapeutic feed ) PASS Direct admission to Phase 2 in NRC 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

Fails appetite test or devlops complications

Phase 1 Inpatient treatment using F-75 diet Return of apetite or reduction of Edema Transition phase T/t or F-100 Diet

Discharge to follow up by AWW

4 Follow Ups at 15 days interval at NRC

Therapeutic feed
Ingredients: Roasted Groundnut - 1000 gm  Milk powder  Sugar  Coconut oil

- 1200 gm - 1120 gm - 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.

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.

HOW TO DO THE APPETITE TEST : 
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.

To pass the Appetite Test the intake of test meal has to be at least in moderate range.
REFERENCE TAB E :- ( Body weight in kg Vs Intake in grams)
BODY WEIGHT 3 - 3.9 4 5.9 6 8.9 7 7.9 8 8.9 9 9.9 10 10.9 12 14.9 POOR <15 <20 <20 <25 <30 <30 <35 <40 MODERATE 15 20 20 - 25 20 30 25 35 30 40 35 45 35 50 40 60 GOOD >20 >25 >30 >35 >40 >45 >50 >60

F-75 FEEDS
( Given to the child in Phase- 2 treatment) Milk ± Sugar ± 28 ml. = ¼ bowl

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

F- 100 FEED
( Given to the child in Phase- 1 Treatment)

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

Medicines to be administered at NRC
Vit A :6-11 months of age ² 1 ml. >12 months of age ² 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]

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