Abstract of Dissertation

Keyword : Child Malnutrition and Treatment Centre (CMTC); Severely Acute Malnutrition (SAM); Rashtriya Bal Suraksha Yojana (RBSK); ASHA (Accredited Social Health Activist)

Objective : To assess the performance of Child Malnutrition and Treatment Centre with respect to its following key output indicator: • Stay at CMTC • Total Weight Gain • Outcome

Background : Malnutrition, as a major public health and nutrition challenges faced by many developing countries, stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors. Particularly India holds the dubious distinction of being the birthplace of a third of the world’s entire population of malnourished children. Almost 20 percent of children under five years of age suffer from wasting due to acute undernutrition. As per the data are shown in the National Family Health Survey 2015-16 almost 9% of the total children are severely malnourished. So, it is essential to evaluate the performance of CMTC so as to come forward with recommendations for future improvement.

Methodology : A follow up prospective study was conducted at 14 Child Malnutrition and Treatment Centre of Banaskantha, Gujarat where 72 children were admitted during the entire month of February 2018. These SAM children were then followed up until the period of their 3rd follow up.” The main source of data collection was slightly modified pre-structured monthly follow up report. In this report, their socio-demographic details and anthropometric measurement were recorded.

Findings : Majority of Severely Acute Malnourished Children (SAM) children belong to age group less than 2 years i.e. (37.5%) most of the admitted children belonged from the OBC (Other Backward Class) (41.6%), SC (Scheduled Caste) (33.33%) and ST (Scheduled Tribe) (18%) and General Category (7%) respectively. ASHAs (Accredited Social Health Activists) played a key role in referring them to CMTC. The death rate was 0%, cure (recovery) rate 65%, defaulter rate 8.33%, mean length of stay (days) at CMTC was 16 and mean weight gain was 10.36g/kg/day. Performance indicators are significantly affected by the length of stay at CMTC. Follow up gradually declined from 1st follow up to 3rd follow up

Recommendations : This study makes us realize the importance of engagement of field level staff in the active screening of SAM children. For this happen, it is necessary to strengthen our screening processes, both in the community and facility level. The inefficacy of RBSK mobile team in screening the SAM children depicts the poor surveillance. There is a need to develop effective supervision and monitoring of RBSK team to strengthen the screening process of SAM children. The low indicator values of recovery rate and high non-respondent rate reflect the inadequacy of the treatment method offered at the facility level. To address this issue operational guidelines given by NHM Gujarat should be religiously followed to ensure the correct formulation and timely administration of feeds. Thus, in conclusion, we can say that with consolidated efforts from all the key stakeholders at various level of the healthcare system, CMTC can be established as an effective intervention to curb the menace of Malnutrition and its associated complication.