Strengthening Psychosocial Stimulation in the Management of Children With Severe Acute Malnutrition: Experience From a Nutrition Rehabilitation Center.

Severe acute malnutrition (SAM) not only increases risk of mortality, but it also increases the risk of impaired motor, cognitive, and psychosocial development. Across the globe, 43% of all children younger than five years of age are at risk of not achieving their developmental potential. The World Health Organization management guidelines for SAM has included the integration of early childhood development (ECD) directed sensory and psychosocial stimulation and structured play therapy in the medico-nutritional care process. Despite this, management still largely focuses on nutrition rehabilitation, while these interventions take a backseat. Most countries are moving towards home-based management of uncomplicated SAM children. Hence, it is equally important to have a strong ECD component in the community-based management programs. Strengthening the support of sensory and psychosocial stimulation and structured play support in both facility and community-based care of SAM children will not only help them to survive, but also thrive and transform. With this background, we briefly describe the experiences of a pilot study aiming at strengthening of these interventions support in 10 nutritional rehabilitation centers across India.

Reliability of coeliac serology in monitoring dietary adherence in children with coeliac disease on a gluten-free diet.

This study aimed to determine the utility of coeliac serology for monitoring dietary adherence in coeliac disease. Serum anti-tTg IgA and anti-DGP IgG levels of 42 newly diagnosed patients were measured at diagnosis and at intervals of three, six and 12 months after starting a gluten-free diet. Both anti-tTg and anti-DGP antibodies decreased in all patients. The decline in the former was significantly greater at 3-12 months throughout, while in the latter the decline was seen only at three months but not subsequently. Serial measurement of coeliac serology may help in monitoring adherence to a gluten-free diet.

Determinants of Stunting, Wasting, and Underweight in Five High-Burden Pockets of Four Indian States.

OBJECTIVES: Prevalence of under-nutrition is very high in India. Under-nutrition is a result of interplay between different immediate, underlying, and basic causes. The study was conducted with the objective to identify significant predictors of stunting, wasting, and underweight. METHODS: Cross-sectional studies with 2299 children from five high-burden pockets of four Indian states were conducted. Primary data on their anthropometric measurements along with their households' demographic and socioeconomic characteristics were collected. Binary logistic regression analyses were performed to examine the predictors of stunting, wasting, and underweight. RESULTS: Results show very high prevalence of stunting, wasting, and underweight in all five regions covered in the study. Multivariate analyses show that food security, use of toilets, and low body mass index status of mothers were the major predictors of stunting and underweight among children. Acute respiratory infection disease was the major predictor of underweight and diarrhea was the major predictor of stunting. Younger children (<24 months) had lower odds of underweight and stunting compared to older children (24-59 months). The analyses showed higher odds of wasting among male children. Regional variations were also seen in the study with higher odds of underweight and wasting in Khuntpani block and higher odds of stunting in Naraini block. CONCLUSION: The above findings indicate that for comprehensively addressing child under-nutrition, it is very important to address maternal nutrition, improve food security, and reduce poverty status, provide better water and sanitation facility to the community, control infections, and address regional disparity.

Experience and Outcome of Children with Severe Acute Malnutrition Using Locally Prepared Therapeutic Diet.

OBJECTIVE: Globally more than 1/3rd of the child deaths are attributed to under nutrition and it continues to be a major public health problem in developing countries. This research paper is an attempt towards intervention and management of severely malnourished children with the use of locally prepared therapeutic diets to bring down the case fatality rate. METHODS: A cross-sectional longitudinal study was undertaken at a tertiary care hospital in North India. Children under 5 y of age fulfilling the WHO case definition of severe acute malnutrition and suffering from medical complications were enrolled and managed on standard WHO protocols using locally prepared therapeutic diet (Starter F-75 diet and Catch-up F-100 diet). RESULTS: During the period of 11 mo, a total of 315 children (192 boys and 123 girls) under 5 y with severe acute malnutrition requiring in-patient care were enrolled and evaluated. The overall case fatality rate was 3.5% while average weight gain seen was 9.33 ± 8.28 g/kg body weight/day and average length of stay was 11.71 ± 7.59. The Nutrition Rehabilitation Centre (NRC) observed a cure rate of 47% and secondary failure rate of 19%. CONCLUSIONS: The present study highlights the integral role of locally prepared therapeutic diet (starter F-75 and F-100) besides standardized care provided at Nutrition Rehabilitation Centre (NRC) to combat malnutrition which is a major scourge in the developing world. To sustain the benefits and prevent relapse, there is a need to integrate the services at NRC with the community-based therapeutic care to deliver continuum of care from facility to door step and vice versa.