Addressing malnutrition through practice : CINI`s Experience

Addressing malnutrition through
practice : CINI’s Experience
Presented by
Dr N C De
Child In Need Institute
West Bengal
www. cini-india.org
Email : [email protected]
CINI – Child In Need Institute, an NGO started 1974-75,
serving the rural poor with the mission
"Sustainable development in health, nutrition, education and
protection of child, adolescent and woman in need“ through
the strategy of integrated Life Cycle Approach (LCA) & Child &
Women Friendly Community (CWFC).
Services Provided
• Under 5 Clinic
• Nutrition Rehabilitation Centre (NRC)
•Training of ICDS, GOVT/NGO workers
• Field Activities & Research
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The Picture of MalnutritionMalnutrition-Today
74 79
80
70
60
51 45
43 40
50
NFHS-2
(98-99)
NFHS-3
(05-06)
40
20 23
30
20
10
0
Stunted
Wasted
Under weight
Anemia
10 Million under 5 die in the world,
2.2 million in India
Comparison of under-nourished
Children Under 3 years of age
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More than 50% of them contributed
by Mal nutrition
Concept of Nutrition
Not by Food alone
FOOD/ENERGY HEALH CARE
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LOVE & CARE
Intergeneration Cycle
Malnourished Child
Low Birth Weight
<2.5 Kg. (1 : 3)
Adolescent
Early Marriage
Malnourished adult
woman
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What goes wrong…
•Non Exclusive Breastfeeding
•Improper complementary food
•Poor hygiene, sanitation and
immunization
•Too-many too soon
Improper Feeding
& Infection
Nutrition
intervention
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•Inadequate care & Support by
family/community
Management of Severe
Malnutrition at NRC.
Admission Criteria Visible Severe wasting and/or bipedal edema,
Lactation failure with recurrent infection and growth
failure.
Rehabilitation
Stabilization Phase- Hypoglycemia, Hypothermia,
Dehydration/Electrolyte imbalance,
Infection/Septicemia, micronutrient deficiency. Eye
problems. (WHO Guidelines)
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Rehabilitation Phase
Feeding
< 6 months of age –
• Breastfeeding – help to breastfeed. Attempt
relactation.
• Prepared feeds
• ‘Nutrimix’(if above 4 months) – ready to use pulse
& cereal based food. Bengal gram/moong dal &
wheat/Rice – 1:4.
•
Mineral Mix/ Mineral Electrolyte Solution* (Ingredients
available in Kolkata Market) can be added to Nutrimix.
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‘Nutrimix’-ready to use food
‘NUTRIMIX’ – a cereal and pulse based food.
Ingredients- Wheat or Rice, Bengal gram or Green
gram, Sugar/jaggery, Vegetable Oil and Water.
How to make ‘Nutrimix’ Powder?
Wheat or rice and pulses in the ratio of 4: 1 (i.e.,
400g and 100g) are measured, roasted separately,
ground to powder and mixed together. The mixture
to be kept in a dry, airtight container and used as
required. One teaspoonful of Nutrimix’ powder
weighs 3.0g (approximately) provides 10 Kcals of
energy and 0.4g of protein.
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‘Nutrimix’
Ingredient
Complementary Food-
Amount (g) Energy (Kcal)
Nutrimix Powder -
250
850
Sugar -
50
200
Veg oil
50
450
Water
Electrolyte mineral soln
700 ml*
20ml
Total – 1500 kcal
*50 ml extra water to allow evaporation
100 gm. Provides 150 kcal and protein 3.5g (approx)
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Protein (g )
35
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Rehabilitation PhasePhase- Contd.
> 6 months of age –
Complimentary food – Nutrimix plays a big role.
Home made complementary food started gradually’Khichri, Halwah, kheer & other Milk based preparations’.
‘Mineral Mix’/Electrolyte Mineral Solution added
to Nutrimix. Vitamins-supplemented.
Continued Breastfeeding
Green vegetables, fruits, eggs and fish included.
Given small amount at a time, 7-8 times a day.
Eating together, separate Plate/Bowl-helps.
Rehabilitation Phase Contd-Contd-
Treatment of associated illness. TB, Parasites, Chronic
Diarrhea.
Empowerment of mother/care givers at NRC- A live
lab, A Center for learning and teaching. Practical
demonstration ground for Behavior Change. Learning
by doing. Learning from each other and practice the
same at home and community.
The Topics:- Feeding, hygiene & sanitation,
immunization, family planning, childhood stimulations.
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Criteria for Discharge
Relief of Symptoms.
Gaining weight Steadily.
Mother/Caregiver Confident of giving
care at congenial home environment.
Father/responsible male member
agrees for follow-up.
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Before
A few illustrations of Nutrition
Rehabilitation Results:www. cini-india.org
After
Lactation failure – Relactation and After--After---
Before
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After
Successful Rehabilitation
Feeding Themselves
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A case study-Marasmic-kwashiorkor
During rehabilitation
On admission
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Grows at home as well.
Wt gain of 2.5 Kg in 45
days. Rate- 9g/kg/day.
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Home/community based
Management and Care.
Who qualifies?
Uncomplicated SAM :- Alert, Appetite preserved,looks well,
conducive home environment, >6 months of age.
What provisions ?
Feeding/caring, micronutrients, continued treatment. Nutrimix plays
a big role. Effective and efficient referral system.
Who Care ?
Family and community, through existing govt. & NGOs. NRHM,
ICDS, PHC, PRI- AWW,ANM,ASHA and Community Volunteers.
NGO - Facilitation,capacity building and development of Child &
Woman Friendly Community (CWFC).
Positive Deviance Approach.
Some children grow better in spite of same
adverse socio-economical environment as
that of their counterpart due to improved
feeding and caring practices. The process is
called Positive Deviance Approach.
It encourages community participation,
learning by doing, self reliance and
sustainability.
CINI’s experience with PD in collaboration
with Govt. and other agencies (UNICEF,
ICDS) have been very encouraging.
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‘Nutrimix’-- Facts.
‘Nutrimix’
Ready to use complementary/supplementary food.
Acceptable,accessible and affordable.
Scaling up- Social marketing-collaboration with other
institutions and funding agency. Funding required for
developing infrastructure and marketing.
Community involvement/participation,decentralization,
profit sharing, self reliance & sustainability.
Produce behavior change in the right direction.
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Challenges to be met.
Community empowerment, sharing
responsibility and accountability for
development of a true Child and Woman
Friendly Community (CWFC).
Provision of quality health services and
delivery of integrated nutrition package (true
convergence).
Development of communication skill at every
level for bringing in behavior change.
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Concluding paragraph.
“Ultimately, there is nothing as important as
informed public discussion and the participation of the
people in pressing for changes that can protect our
lives and liberties. The public has to see itself not
merely as a patient, but also as an agent of change. The
penalty of inaction and apathy can be illness & death.”
--Concluding remark by
Amartya Sen
in
“Health in Development”
Keynote address to fifty Second World Health Assembly, Geneva,
May 1999 {Bulletin of the WHO, 1999(77)}
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Accountability
and sharing responsibility.
Thank you