Magnitude of childhood malnutrition is one of the major causes for the burden of morbidity and mortality of children in Bangladesh. Even though Bangladesh has achieved some significant improvement in reducing childhood mortality in 2012, 1.4% of the under 5 childhood mortality was directly associated with malnutrition. Nutritional status has been marked as one of the top 5 major reasons of under five childhood mortality. The treatment of severe acute malnutrition occupies a unique position between clinical medicine and public health. The causes are essentially poverty, social exclusion, poor public health, and loss of entitlement, and most cases can be prevented by economic development and public-health measures designed to increase dietary quantity and quality alone, with no need for clinical input.
General objective of this study is to see the impact of selected improved recipes on nutritional status of SAM and Severe undernourished children.
1. To observe the status of recovery from SAM by applying regular food to SAM children eg.Weight gain.
2. To test the efficacy of locally available homemade foods to manage SAM.
3. To assess the WAZ of the studied children at enrollment and after discharge.
4. To observe the acceptability of these homemade recipes among people.
5. To assess the cost of locally available homemade food.
Current Status: On going
In Bangladesh management of SAM children at the facility level and community level includes the use of commercially produced milk based therapeutic food F-75 and F-100. On the other hand there is an increased interest of using RUTF (a high energy dense therapeutic food) to manage SAM. But most of its energy comes from fat and the principle is to gain weight in relatively short time. But a child doesn’t become severely malnourished in 2 weeks and there is no justified reason that they need to gain weight within this short time. Use of this high fat content to gain weight ignores the growth of muscle and bone, only deposition of fat in thigh and buttocks and weight gain is not a significant indicator to convince that the child will not become malnourished again when treatment period (2 weeks) will be over. Besides feeding children with these commercially produced therapeutic food ignores that when the child will go home they will have to eat the usual home diet. Therefore it is necessary to introduce mothers of SAM children with innovative ideas to produce homemade nutritious recipes adequate to attend the catch up growth and improve their nutritional status. It may take a longer time compared to commercially produce therapeutic foods but it is feasible, sustainable and scientific. The foods that will be given to the children is well tested in moderate malnourished children, which is nutritionally sound and easy-to-prepare complementary foods containing common, inexpensive, locally available foods and adequate nutrients dense28.Through this pilot project the impact of 6 scientifically developed improved recipes for treating malnourished children will be measured. This will be used as a scientific proof for managing SAM with home based diet.
Procedure of the intervention:
Following baseline data collection, for first 3-4 days children are fed with milk, sugar, oil based liquid feed (F-75/F-100). Children who have infection are provided with F-75 or F-100 for 2 days. Then the child is fed with homemade complementary improved food recipes to provide 100-110 kcal/kg body wt/day to the selected children. After successful feeding of these foods for first 4 days considering the condition of the children the given homemade recipes will be increased to provide 130-150 kcal/kg/day from the 5th day onwards up to 10th day of the intervention.Team members screen patients by using WHO growth and height chart. After selecting the patients they are taken to the SAM unit and questionnaire is filled up. They are counseled on proper dietary intake, appropriate way of breastfeeding and its importance, Complementary feeding etc. After that they are given demonstration on food preparation. The children are on 2 hourly feeding patterns. After giving food team members follow up patients at every interval to observe patient status whether he/she is taking meal properly or not, or if there is any problem. Team members also observe if patient caregiver’s maintaining proper hygiene or not. Every day on counseling session team members emphasize on hygiene and sanitation.
IEC materials (e.g. posters, leaflets, flip chart etc) are used to describe the benefits of feeding different locally available and home-made food to improve their child’s nutritional status and how to prepare and feed. They are taught how to take care of their children and what necessary steps they should be followed to reduce disease frequency among their children.
Counseling on Home Feeding:
The mothers of the children will be taught to prepare khichuri at home from cooked items such as rice, fish/meat/egg, vegetable, dal and milk with 5tsp oil to give children 4-5 times a day. Seasonal fruits will be advised to give children eg, orange, plums, banana, mango, jackfruit, papaya, guava etc. Till now seven among thirty seven baseline data are collected to assess the feeding practice and nutritional status of the children through the pre-structured questionnaire and digital recorder. Nutrition education is provided to the mothers of the children by using the developed IEC materials (e.g. posters, leaflets, flip chart etc) to make them aware regarding benefits of different home-made food and this is indispensable for their children to improve nutritional status and demonstrate how to prepare the selected locally available food. Every day Research Assistants are monitoring the weight and measuring height once a week of the children. After discharging from hospital Research Assistants follow up the children once a week and also monitor the weight, height and MUAC measurement.