Let's fightTogetherAgainst Malnutrition

What is Nutrition Rehabilitation Centre

Nutrition Rehabilitation Center (NRC) is a in a health facility where children with Severe Acute Malnutrition (SAM) are admitted and managed. A steady linkage with ICDS identifies and refers severely malnourished children in the community using MUAC tape. Children are admitted in NRC as per the defined admission criteria adopted in line with IAP 2006 and new WHO 2009 recommendations and provided with medical and nutritional therapeutic care.

Once discharged from the NRC, the child continues to be in the Nutrition Rehabilitation program till she/he attains the defined discharge criteria from the program. In addition to curative care special focus is given on timely, adequate and appropriate feeding for children; and on improving the skills of mothers and caregivers on complete age appropriate caring and feeding practices. In addition, efforts are made to build the capacity of mothers/caregivers through counselling and support to identify the nutrition and health problems in their child.

Admission & Discharge Criteria:

Children less than 6 months

  • Admission Criteria
    • Problem of breastfeeding: the infant is too weak to suck AND/OR
    • The mother has not enough milk AND/OR
    • Biletral pitting oedema AND/OR
    • W/H or W/L <-3 Z score (WHO-2005 standards)
  • Discharge Criteria
    • Child is gaining weight on breast milk alone, regardless of current weight or W/H%
    • No medical Complications
    • Absence of Bilateral Oedema for at least past 10 days
  • For children <6 months of age suffering from severe acute malnutrition, emphasis is laid on supporting and sustaining breastfeeding through counselling and re-establishment of lactation in mothers with lactation failure using supplementary suckling technique (SST).

Children age 6 months upto 60 months

  • Admission Criteria
    • W/H or W/L <-3 Z score (WHO-2005 standards) AND/OR
    • MUAC <11.5cm AND/OR
    • Presence of bilateral oedema AND/OR
  • Discharge Criteria
    • 15 % Weight gain from Admission Wt. or weight on the day free of oedema
    • Absence of Bilateral Oedema for at least 10 days
    • No medical Complications

Infrastructure

NRCs are essentially set up in district hospital campus and Community Health Centers with NRC ward of bed strength of 20 or 10, a kitchen with proper cooking and feed demonstration space and attached toilets/bathrooms. A possibility of having kitchen garden can also be explored considering the availability of space. NRC wards are painted with child friendly pictures keeping in mind the emotional and psychosocial development of child. The SAM children admitted continue their stay in NRC for 14-21 days. Four follow ups of the children discharged from NRC at an interval of 15 days is done. The criteria for discharge of children 6m-60m from the programme is 15% weight gain of the admission weight (WHO recommendation 2009).

Human Resource

NRCs in M.P. is in form of Facility based care unit governed by

  • One Incharge Medical Officer
  • One Female Feeding demonstrator
  • 2 Nurse/ANM (10 Bedded NRC)/3 Nurse/ANM (20 Bedded NRC)
  • 1 Cook (10 Bedded NRC)/2 Cook (20 Bedded NRC)
  • 2 Caretakers (10 Bedded NRC)/3 care takers (20 Bedded NRC)