Comparison of Janani Suraksha Yojana (JSY) and augmented Arogya Laxmi scheme (ALS) in improving maternal and child health outcomes in urban settlements of Hyderabad, South India.

BACKGROUND: India accounts for the largest number of global neonatal deaths with around 20 per 1000 live births. To improve the utilization of government services for institutional deliveries, Augmented Arogya Laxmi Scheme (ALS) was launched in Telangana state of southern India. This study assessed the effectiveness of the Janani Suraksha Yojana (JSY), which combines cash assistance with delivery and post-delivery care, in comparison to ALS in improving the outcomes related to antenatal, natal, and postnatal care in urban settlements of Hyderabad, Telangana, southern India. METHODS: This was a two-year cross-sectional study conducted in 14 urban settlements of Hyderabad city from September 2017- August 2019. All mothers delivered during the 18 months preceding the survey were enrolled after a written informed consent. Field investigators collected data on variables related to socio-demographic characteristics, awareness, and utilization of JSY and ALS programs. Variables related to antenatal history, antenatal care, complications during birth, delivery outcomes, newborn care, and postnatal care till 28 days were assessed. We used multivariable logistic regression model to examine the association between the different maternal, child, and socio-demographic characteristics of the two study groups. RESULTS: A total of 926 mothers were beneficiaries of Janani Suraksha Yojana (JSY) program while 933 mothers were beneficiaries of augmented Arogya Laxmi Scheme (ALS). Mothers in ALS group (AOR 1.71; 95% CI 1.21-2.43) were at increased odds of having more than eight antenatal care (ANC) visits compared to the mothers availing JSY. Mothers in ALS group were at decreased odds of having complications like severe pain in the abdomen (AOR 0.43; 95% CI 0.22-0.86), swelling of legs or feet (AOR 0.59; 95% CI 0.44-0.80) compared to mothers in JSY group. Children of mothers in the ALS group had increased odds of receiving breastfeeding within 30 minutes of birth (AOR 1.46; 95% CI 1.13-1.88) compared to children of mothers in JSY group. CONCLUSIONS: The newly launched augmented ALS led to the increased utilization of the government health facilities and improved the maternal and child health outcomes.

Impact of COVID-19 during pregnancy on placental pathology, maternal and neonatal outcome - A cross-sectional study on anemic term pregnant women from a tertiary care hospital in southern India.

Background: SARS-CoV-2 infection during pregnancy may cause adverse maternal, neonatal and placental outcomes. While tissue hypoxia is often reported in COVID-19 patients, pregnant women with anemia are suspected to be more prone to placental hypoxia-related injuries. Methods: This hospital-based cross-sectional study was conducted between August-November 2021, during COVID-19 second wave in India. Term pregnant women (N=212) admitted to hospital for delivery were enrolled consecutively. Since hospital admission mandated negative RT-PCR test for SARS-CoV-2 virus, none had active infection. Data on socio-demography, COVID-19 history, maternal, obstetric, and neonatal outcomes were recorded. Pre-delivery maternal and post-delivery cord blood samples were tested for hematological parameters and SARS-CoV-2 IgG. Placentae were studied for histology. Results: Of 212 women, 122 (58%) were seropositive for SARS-CoV-2 IgG, but none reported COVID-19 history; 134 (63.2%) were anemic. In seropositive women, hemoglobin (p=0.04), total WBC (p=0.009), lymphocytes (p=0.005) and neutrophils (p=0.02) were significantly higher, while ferritin was high, but not significant and neutrophils to lymphocytes (p=0.12) and platelets to lymphocytes ratios (p=0.03) were lower. Neonatal outcomes were similar. All RBC parameters and serum ferritin were significantly lower in anemic mothers but not in cord blood, except RDW that was significantly higher in both, maternal (p=0.007) and cord (p=0.008) blood from seropositive anemic group compared to other groups. Placental histology showed significant increase in villous hypervascularity (p=0.000), dilated villous capillaries (p=0.000), and syncytiotrophoblasts (p=0.02) in seropositive group, typically suggesting placental hypoxia. Maternal anemia was not associated with any histological parameters. Univariate and multivariate logistic regression analyses of placental histopathological adverse outcomes showed strong association with SARS-CoV-2 seropositivity but not with maternal anemia. When adjusted for several covariates, including anemia, SARS-CoV-2 seropositivity emerged as independent risk factor for severe chorangiosis (AOR 8.74, 95% CI 3.51-21.76, p<0.000), dilated blood vessels (AOR 12.74, 95% CI 5.46-29.75, p<0.000), syncytiotrophoblasts (AOR 2.86, 95% CI 1.36-5.99, p=0.005) and villus agglutination (AOR 9.27, 95% CI 3.68-23.32, p<0.000). Conclusion: Asymptomatic COVID-19 during pregnancy seemed to be associated with various abnormal placental histopathologic changes related to placental hypoxia independent of maternal anemia status. Our data supports an independent role of SARS-CoV-2 in causing placental hypoxia in pregnant women.

Challenges in Accessing and Delivering Maternal and Child Health Services during the COVID-19 Pandemic: A Cross-Sectional Rapid Survey from Six States of India.

BACKGROUND/OBJECTIVES: Globally, the COVID-19 pandemic and its prevention and control policies have impacted maternal and child health (MCH) services. This study documents the challenges faced by patients in accessing MCH services, and the experiences of health care providers in delivering those services during the COVID-19 outbreak, explicitly focusing on the lockdown period in India. METHODS: A cross-sectional study (rapid survey) was conducted in 18 districts from 6 states of India during March to June, 2020. The sample size included 540 MCH patients, 18 gynaecologists, 18 paediatricians, 18 district immunisation officers and 108 frontline health workers. Bivariate analysis and multivariable analysis were used to assess the association between sociodemographic characteristics, and challenges faced by the patients. RESULTS: More than one-third of patients (n = 212; 39%) reported that accessing MCH services was a challenge during the lockdown period, with major challenges being transportation-related difficulties (n = 99; 46%) unavailability of hospital-based services (n = 54; 23%) and interrupted outreach health services (n = 39; 18.4%). The supply-side challenges mainly included lack of infrastructural preparedness for outbreak situations, and a shortage of human resources. CONCLUSIONS/RECOMMENDATIONS: A holistic approach is required that focuses on both preparedness and response to the outbreak, as well reassignment and reinforcement of health care professionals to continue catering to and maintaining essential MCH services during the pandemic.

Maternal Nutrition, Body Composition and Gestational Weight Gain on Low Birth Weight and Small for Gestational Age-A Cohort Study in an Indian Urban Slum.

Maternal nutritional status and care during pregnancy are essential for adequate birth weight. In this prospective cohort study (N = 1061) in an urban slum, we investigated the association of maternal anthropometry, body composition, gestational weight gain and dietary intakes with low birthweight (LBW, <2.5 kg). About one-third of the women were short (<150 cm), 35% were underweight (<45 kg), 23% suffered from chronic energy deficiency (CED, BMI < 18.5 kg/m2) and another 30% were overweight/obese. The mean age and BMI were 23 years and 21.7 kg/m2, respectively, and haemoglobin was 10.73 g/dL. The mean birthweight (N = 605) was 2.81 ± 0.5 kg, and the average gestational age was 38 ± 2 weeks. About 15% of infants had LBW, and 48% were small for gestational age (SGA). Maternal body composition was assessed by skinfold thickness (SFT) in all trimesters. In the first trimester (N = 762), we found that mean fat-free mass (FFM), fat mass (FM) and body fat percentage (% BF) were 38.86 kg, 11.43 kg and 21.55%, respectively. Low birthweight was significantly associated with preterm deliveries (p < 0.001) and less fat free mass (p = 0.02) in the third trimester. Among other factors were age (p = 0.017), maternal anthropometry (height: p = 0.031; weight: p = 0.059) and fewer antenatal check-ups (p = 0.037). Small size (SGA) was consistently associated with maternal bodyweight at all trimesters (term I, p = 0.013, term II, p = 0.003 and term III, p < 0.001), fat mass in the third trimester (p < 0.001) and maternal height (p = 0.003).

Acceptability of Locally Produced Ready to Use Therapeutic Food (RUTF) in Malnourished Children: A Randomized, Double-Blind, Crossover Study.

OBJECTIVE: To compare the acceptability of a locally produced ready-to-use therapeutic food (L-RUTF) with the standard ready-to-use therapeutic food (S-RUTF). METHODS: It was a single-center, randomized, double-blind, two-way crossover study. The participants were 6-59-mo-old children residing in an urban slum, with weight-for-height z score (WHZ) < -2SD. The study had two intervention periods of feeding with two types of RUTF- L-RUTF and S-RUTF-for a period of 24 h, separated by a wash-out period of 7 d. The outcome measures were the acceptability measured as consumption of more than two-thirds of the total calories offered (150 kcal/kg/24 h) and the degree of liking of the food measured by organoleptic evaluation. RESULT: Both types of RUTF did not qualify as acceptable. L-RUTF was preferred over S-RUTF in organoleptic evaluation. CONCLUSION: The study suggests that RUTF products are not suitable for use as a single therapeutic food during nutrition rehabilitation of children with acute malnutrition. The study was registered in the clinical registry of India; Reg. No: CTRI/2018/04/012967.

High dietary micronutrient inadequacy in peri-urban school children from a district in South India: Potential for staple food fortification and nutrient supplementation.

Multiple micronutrient deficiencies (MNDs) co-exist, often because of poor intakes and adversely impact health. Habitual diets were assessed in 300 school children (6-17 years old) recruited from two government schools by simple random sampling. Probability of adequacy (PA) for 11 micronutrients and mean probability of adequacy (MPA) was calculated. Haemoglobin, plasma ferritin, folic acid, vitamin B12 and C-reactive protein were estimated. Descriptive statistics and regression analysis were used to estimate magnitude and factors associated with MNDs. The contribution of fortified foods and/or supplements in addressing inadequacies and excessive intakes was modelled. The PA ranged from 0.04 for folate to 0.70 for zinc, and the MPA was 0.27. Prevalence of anaemia (53%), iron deficiency (57%; ID), iron deficiency anaemia (38%; IDA), folate deficiency (24%) and B12 deficiency (43%) was high. Dietary inadequacy of iron, zinc and a low MPA was associated with anaemia and IDA. Inclusion of double fortified salt (DFS), fortified rice (FR) or iron folic acid (IFA) supplements individually in habitual diet reduced probability of iron inadequacy significantly from 82% to ≤13%. Inclusion of DFS and FR simultaneously led to disappearance of iron inadequacy, but risk of excessive intake increased to 16%. Inclusion of DFS, FR and IFA together increased risk of excess iron intake to 40%. Nevertheless, intakes of folate and B12 remained inadequate even with FR and/or IFA. These results indicate a high risk of dietary MNDs in children and suggest need for more systematic intake measurements in representative sample and adjustment of iron dosages to avoid excessive intakes.

Comorbidities associated with non- healing of plantar ulcers in leprosy patients.

BACKGROUND: Non-healing plantar ulcers are one of the significant causes of disability in leprosy patients. Plantar ulcers often take months or years to heal, affecting the patient's quality of life. Presence of comorbid conditions in these patients can delay wound healing. The study aimed to evaluate the role of associated comorbid conditions as risk factors in ulcer healing. METHODOLOGY/PRINCIPAL FINDINGS: A total of 66 leprosy patients with plantar ulcers registered at LEPRA Society-Blue Peter Public Health and Research Center (BPHRC), Hyderabad, India from June 2018 to June 2019 were studied. Comprehensive clinical assessment was done, including screening for comorbid conditions and treated as per the recommended guidelines. About two-thirds of the participants were aged 50 and above, of which more than half were illiterates, and 93.5% were living below the poverty line. Majority of ulcers were seen on the forefoot; with the head of meta-tarsal bone 27 (41.6%) as the commonest site, followed by calcaneum 23 (38.3%) and great toe 10 (16.6%). Mean ulcer depth was 0.61 (0.57) cm, the area was 5.24 (6.73) cm2 and ulcer volume was 4.72 (14.33) cm3. Ulcer dimensions were significantly associated with low body mass index, hypertension and smoking. CONCLUSIONS/SIGNIFICANCE: Identifying the risk factors delaying wound healing and detailed assessment of ulcers are of profound importance to predict the outcome of plantar ulcers in leprosy patients. The study findings indicate the need for better policies by the leprosy control program for the comprehensive management of plantar ulcers.

Nutrition rehabilitation of children with severe acute malnutrition: Revisiting studies undertaken by the National Institute of Nutrition.

Severe acute malnutrition (SAM) in children under five years is an important public health problem due to associated high mortality and long-term health consequences. Research on the dietary causes of SAM, especially the role and relative importance of dietary protein, in the aetiology of oedematous malnutrition, has led to considerable debates and controversies. The present article revisits some of the debates in this field, where the researchers at the National Institute of Nutrition (NIN), Hyderabad, India, with their pioneering work, have contributed to the global literature on the various facets of the disease. Highlighting the importance of energy as a bigger problem than protein malnutrition is a noteworthy contribution of NIN's research. It is, however, important to examine the protein quality of the diets in light of the new information on the lysine requirements. The article argues that the currently dominating hypothesis of free radical theory requires a critical review of the supporting evidence. Over the past few decades, the research has focused on low-cost diets using locally available foods. The article also argues that solutions based on local foods, being acceptable and sustainable, need to be strengthened for their effective delivery through the existing nutrition programmes. Recent evidence shows that the use of ready-to-use therapeutic foods (RUTF) with high micronutrient density may be linked with higher mortality possibly due to the high iron content, which could be counterproductive. There are several unaddressed concerns regarding the potential long-term impact of consumption of RUTF in children with SAM. More evidence and a cautious approach are, therefore, needed before implementing these solutions.

Immunization uptake and its determinants among the internal migrant population living in nonnotified slums of Hyderabad city, India.

BACKGROUND: The aim of this study is to assess the childhood immunization uptake and its determinants among the internal migrant population living in nonnotified slums of Hyderabad City, India. METHODOLOGY: This is a cross-sectional study of 768 rural-urban migrant mothers with a child under 2 years of age residing for period minimum of 30 days, but not more than 10 years. Data were collected for sociodemographic details, health-seeking behavior, antenatal, postnatal services, and reception of vaccines appropriate for age. RESULTS: Full immunization coverage among the children of migrants was same as the general population of the State of Telangana (66.7%). The likelihood of child's reception of full immunization decreases with age of the mother and rose with the attainment of higher education. The head of household of salaried class, expectant mothers utilizing antenatal services, and the visit of postnatal health worker for counseling of expectant mothers, were significantly associated with reception of full immunization. Immunization coverage rates of children of 12-23 months age is lower than the general population of Telangana. The frequency of visits by health worker is low. CONCLUSION: Immunization uptake among the migrants and vulnerable segments of the population can be increased by locating new settlements, improving utilization of services and capacity building of health staff.

Secular Trends in Heights and Weights in Boys and Girls Over 3 Decades in Rural India.

BACKGROUND: Secular trends in height reported from developing countries are few and scarce. OBJECTIVE: To assess secular trends in linear growth in boys and girls from birth to 18 years of life in rural households of India based on periodical cross-sectional surveys conducted over a period of 35 years. MATERIALS AND METHODS: The present study uses data from baseline and final surveys of National Nutrition Monitoring Bureau from 1975 to 1979 (N = 6043) to 2012 to 2013 (N = 11 910) on anthropometry from birth to 18 years from 7 states in households of rural India. RESULTS: The overall improvement in 18+ boys and girls was 3.1 and 1.0 cm, respectively, over a period of 35 years. The increments in height of 18+ were highest for both boys (7.4 cm) and girls (4.8 cm) in the state of Kerala followed by Tamil Nadu (boys, 7.3 cm and girls, 3.8 cm). Under-5 stunting rates reduced from 82% in the baseline survey to 45.7% in the final survey at 1.35% per year in the pooled states and was similar in both boys and girls. The recovery in stunting was highest in Tamil Nadu (1.63% per year) followed by Kerala (1.46% per year). CONCLUSION: The pattern of secular trends in height in rural India seen over 3 decades was strikingly similar to that of developed countries. The phenomenal improvement in linear growth in Kerala and Tamil Nadu in children younger than 5 years and adolescents suggests that growth potential for Indians is similar to that of developed countries.

Do South Indian newborn babies have higher fat percentage for a given birth weight?

BACKGROUND: India is experiencing rapidly escalating epidemics of diabetes and cardiovascular disease. High fat percent in Indian adults may have its origins at birth (Fetal origin hypothesis). Conflicting evidence from India have shown increased or similar fat mass in Indian newborn babies compared to western countries. AIM: To compare body composition of term infants with data from similar studies in India and developed countries. STUDY DESIGN: Cross-sectional study in newborn infants at the antenatal ward of a tertiary care hospital in South India. SUBJECTS: 626 mothers and their newborn babies. OUTCOME MEASURES: Maternal body weight and height, baby weight, length, head circumference, skin folds at three sites. Body fat, arm muscle area and arm muscle index were calculated based on known methods. RESULTS: Mean (SD) birth weight of newborn babies was 2.80 (0.37) kg and 43% of them were small for gestational age. Birth weight was significantly related to subscapular (r=0.445; p<0.001) and triceps (r=0.567; p<0.001) skin fold thickness. Mean (CI) Subscapular skin fold thickness and total body fat % was 3.81mm (3.74-3.97) and 10.5% (10.2-10.8). Mean total body fat % for small for gestational age (SGA) (9.57%) was significantly lower than appropriate for gestational age (AGA) babies (11.7%). CONCLUSIONS: The mean body fat percent in AGA infants was similar to that of studies reported on term infants of developed countries, suggesting that South Indian babies may accumulate similar fat mass with increasing birth weight and gestational age.

Effect of Nutrition Supplementation in Children Living with HIV at ART Centre.

OBJECTIVE: To assess the benefits of nutrition supplementation in children living with HIV (CLHIV). METHODS: A prospective observational study was carried out at antiretroviral therapy (ART)/pediatric centre of excellence (PCOE), Niloufer hospital for a period of one year in CLHIV (N = 164) aged 1 to 18 y referred to ART/PCOE. Nutrition supplementation was given in the form of Ready to Use Food (About 350 kcal and 12 g of protein per day) supplementation to assess improvement in Height for age Z (HAZ), Weight for Age Z (WAZ), Weight for Height Z (WHZ) and Body Mass Index for age Z (BMIZ) scores over a period of one year. RESULTS: At baseline, 65.5 % and 57.5 % of children below and above 5 y respectively were stunted. 24.1 % and 45.3 % children below and above 5 y respectively were wasted/thin (as assessed by BMI for age). Mean BMIZ score significantly improved in both the age groups (0.96 Z score, P < 0.001) in below and above 5 (0.37 Z score, P < 0.001) respectively at the end of 12 mo. Mean HAZ score also significantly improved in children above 5 y (0.09 Z score, P < 0.05) with non-significant improvement below 5 y (0.14 Z score, P < 0.57) by the end of 12 mo. CONCLUSIONS: Nutrition supplementation over one year resulted in moderate improvement in the nutritional status of CLHIV. However, it is unclear, whether the improvement in nutritional status was due to regular visits to ART centre that may have resulted in better adherence to treatment or an additional benefit of nutrition intervention. This warrants a well-designed randomized controlled trial to examine the benefits of nutrition supplementation in CLHIV attending ART centre.

Is the Association between Vitamin D and Cardiovascular Disease Risk Confounded by Obesity? Evidence from the Andhra Pradesh Children and Parents Study (APCAPS).

BACKGROUND: Evidence of an association between serum vitamin D and cardiovascular disease risk is inconsistent and comes predominantly from studies in high-income settings. We assessed the association between serum levels of 25-hydroxyvitamin D3 (25(OH)D) and cardiovascular disease risk factors in a population of young Indian adults. METHODS: Cross-sectional analyses of data from APCAPS (Andhra Pradesh Children and Parents Study); a prospective birth cohort study in rural south India. Participants were 1038 (40.3% females) adults aged 18-24 years. Main outcome measures were blood pressures, fasting serum lipids (cholesterols and triglycerides), fasting glucose, insulin, measures of arterial stiffness (aortic augmentation index and aortic pulse wave velocity (aPWV)), carotid intima-media thickness, body mass index (BMI) and body fat (dual X-ray absorptiometry). RESULTS: Vitamin D deficiency (≤20ng/ml) was observed in 41.1% of this lean (mean BMI: 19.5) and active (mean minutes of moderate or vigorous physical activity per day: 186) population. Vitamin D deficiency was associated with higher median body fat in both males (15.9% body fat in vitamin D deficient males vs. 14.6% in non-deficient males, p<0.05) and females (29.1% body fat in vitamin D deficient females vs. 27.8% in non-deficient females, p<0.05) but no associations were observed between vitamin D deficiency and mean BMI or median fat mass index (FMI). Except a weak inverse association with fasting insulin in males, there was no clear association between serum vitamin D levels and cardiovascular disease risk factors in fully adjusted models. CONCLUSIONS: We did not find clear evidence for an association between serum vitamin D levels and cardiovascular disease risk factors. Our results, consistent with the limited evidence from randomised trials of vitamin D supplementation and Mendelian randomisation experiments, suggest that the postulated link between serum vitamin D and cardiovascular disease may be non-causal. Instead, it may be attributable to confounding by lifestyle factors such as obesity and physical inactivity which may provide more fruitful targets for cardiovascular disease prevention.

Secular trends in height in different states of India in relation to socioeconomic characteristics and dietary intakes.

BACKGROUND: Information on adult height and associated secular trends in relation to socioeconomic characteristics based on a nationally representative sample is not available from India. OBJECTIVE: To assess the average adult height and secular trends in height in different states of India in relation to socioeconomic characteristics and dietary intakes according to data from the Third National Family Health Survey (NFHS 3). METHODS: Average heights and associated secular trends were analyzed for each state and in relation to socioeconomic variables. Bivariate and multiple regression analyses were performed to examine the association of socioeconomic factors and consumption of animal-source foods with height. RESULTS: Data from anthropometric measurements were available for 69,245 men and 118,796 women in the age group from 20 to 49 years. The average heights of adult men and women were 165 and 152 cm, respectively, with wide variation among states. Overall, there was a modest secular increase in height (0.50 cm per decade in men and 0.22 cm per decade in women), with a negative secular trend in some of the states. There were striking regional differences in the average heights and the secular trends in height. Similarly, higher socioeconomic status was associated with greater height and a greater secular increase in height. Milk consumption had a positive association with height in men (r = 0.69, p < .001) and women (r = 0.63, p < .001) in various/ different states. CONCLUSIONS: The secular increase in height has been modest in India in spite of impressive economic growth. Consumption patterns of milk in different states may be related to the regional differences in height.

Pattern of growth faltering and recovery in under 5 children in India using WHO growth standards--a study on First and Third National Family Health Survey.

OBJECTIVE: To examine the pattern of growth faltering in preschool children, using World Health Organization (WHO) growth standards 2006 from the available datasets of first and third National Family Health Survey (NFHS 1 and 3). DESIGN: Data-analysis of two large-scale cross-sectional surveys done at a gap of 15 years. SETTING: General community. SUBJECTS: Preschool children included in NFHS 1 (n = 37,768) and NFHS 3 (n = 41,306). MAIN OUTCOME MEASURES: Weight for age Z-scores (WAZ), height for age Z scores (HAZ) and weight for height Z scores (WHZ) based on WHO growth standards for the first four years of life. RESULTS: Mean WAZ score at 0 month during first and third surveys were -1.15 (n=268) and -0.76 (n=184), respectively. Of the total growth faltering in weight for age Z (WAZ) score by the end of third year, 55% and 44% of the growth faltering was already present at birth for the first and third survey, respectively. There was no change in weight for height Z (WHZ) score for the first three years during both the surveys. CONCLUSIONS: A good part of the total growth faltering in India has already taken place at birth. Much of the growth faltering in early life can be attributed to faltering in HAZ scores or stunting. Understanding the causal role of stunting and its prevention as well as improving birth weight appears to be the key for better efficacy of public health programs in preventing under-5 malnutrition in India.

Hospital based nutrition rehabilitation of severely undernourished children using energy dense local foods.

OBJECTIVE: To examine the catch up growth in severely wasted children using energy dense local foods at a hospital based nutrition rehabilitation unit. DESIGN: Retrospective cohort. SETTING: In-patient ward at a tertiary care government pediatric hospital in Hyderabad. PATIENTS: Children with severe malnutrition (n=309) admitted to nutrition ward from January 2001 to December 2005. INTERVENTION: A diet based on energy dense local foods along with multivitamin-multimineral supplements. MAIN OUTCOME MEASURES: Catch up growth (g/kg/day) during each week of hospital stay. RESULTS: Mean age of the children was 25 months (range 2-60). Their baseline weight for height (WHZ) Z score was -4.1. Mean weight gain was moderate (5g/kg/day) and baseline WHZ score had a significant negative relationship to the weight gain. The prevalence of morbidities was high and the commonest morbidity was fever. Weight gain was higher by almost 40% in the absence of morbidities in any week. CONCLUSIONS: The diet based on local energy dense foods was found to be suitable for the nutrition rehabilitation of severely malnourished children though the rate of weight gain was moderate.