Original Article Evaluation of malnutritionMedical in children Journal admittedof Pokhara in Academynutritional of rehabilitation Health Sciences home Vol.. Paudel 3 Issue G 2A. et. al. Evaluation of Malnutrition in Children Admitted in Nutritional Rehabilitation Home of Pokhara Academy of Health Sciences- A Retrospective Cross-sectional Hospital Based Study. Amrita Ghimire Paudel1 ,Gita Ghimire2 , Shreekrishna Shrestha1 , Ramchandra Bastola1 , Yagyaraj Sigdel1, Nirmaya Gurung3 1Department of Pediatrics, Pokhara Academy of Health Sciences, Western Regional Hospital 2Pokhara Nursing Campus, TU, IOM 3Nutritional Rehabilitation Home, Pokhara Academy of Health Sciences ABSTRACT Correspondence Introduction: The burden of malnutrition is of Dr. Amrita Ghimire Paudel, significant concern in Nepal. The objectives of this study are to classify the nutritional status in children admitted Department of Pediatrics, in nutritional rehabilitation home of Pokhara Academy Pokhara Academy of Health Sciences, of Health Sciences and to relate the demographic characteristicsand the effectiveness of the nutritional Western Regional Hospital, Pokhara, Nepal. intervention measures on status of malnutrition which can help in the policy formulation to tackle the burden of malnutrition. Email: [email protected] Materials and Methods: This is a hospital based Article received: Aug 19 2020 retrospective study in which total of 238 children with malnutrition admitted in nutritional rehabilitation home Article accepted: October 14 2020 of Pokhara Academy of Health Sciences during July 2014 to July 2018 were followed. The socio-demographic factors and nutritional status were analyzed at admission and at discharge using the available record. Data was analyzed using SPSS 16. Results: Out of 238 malnourished children, 167(70.2%) were cases of moderate acute malnutrition and 76(29.8%) were cases of severe acute malnutrition. The mean weight at admission was 7.18±1.73 kg, mean weight at discharge was 7.82±1.82 kg and mean weight increased after nutritional intervention was 0.62 kg±0.40. The average weight gain in severe acute malnutrition was 4.7gm/kg/day. A statistically significant difference was obtained between meanweight (p=0.00, t= - 24.62) of children at admission and discharge.There was significant statistical difference between mean weight gain (p<0.05, t= -3.1) in severe acute malnutrition (0.76±0.49 kg) and in moderate acute malnutrition (0.59±0.34 kg). Conclusion: Nutritional rehabilitation homes are effective in improving the nutritional status of undernourished children, more effective in severe acute malnutrition. However it is important to reassess the management protocol to meet the intake targets so that the rate of weight gain is improved. Keywords: Moderate acute malnutrition; nutritional rehabilitation home; severe acute malnutrition. ~281~˷ Original Article Medical Journal of Pokhara Academy of Health Sciences Vol. 3 Issue 2 INTRODUCTION sustain the progress we have made so far and is likely to unmask the iceberg of under nutrition and The burden and consequences of malnutrition hidden hunger. especially under nutrition are of significant concern for an underdeveloped country like Nepal where To address this issue, Government of Nepal has around 1 million children under 5 years (36 %) implemented various policies and one of them suffer from chronic malnutrition (stunting), 10% is integrated management of acute malnutrition suffer from acute malnutrition (wasting or low (IMAM). IMAM has four components out of weight-for-height) and 27% are underweight.1 In which Inpatient Therapeutic Care (ITC) involves Gandaki province, among the under 5 children management of complicated cases of severe acute the incidence of chronic malnutrition is 29%, the malnutrition (SAM) according to WHO protocols incidence of acute malnutrition is 6% and 15% of on an inpatient basis at tertiary level facilities the under 5 children are underweight.1 (hospitals) or nutrition rehabilitation homes (NRH). Nepal has around 20 nutritional rehabilitation homes Various studies show that severely wasted children for the management of severe acute malnutrition have a greater than nine fold increased risk (relative and moderate acute malnutrition in various risk of 9.4) of dying compared to a well-nourished provinces. NRH is a specialized facility intended child, and moderately wasted children has a to rehabilitate malnourished children and was 2 threefold increased risk. Evidences indicate that initiated as a project by Olga Murray, the president wasting or poor weight gain may lead to higher of Nepal Youth Foundation in 1998 A.D. It worked 3 risk of stunting in children. The occurrence of with the zonal hospitals in Nepal, and was later on stunting, severe wasting and intrauterine growth handed over to the government after five years of retardation together are responsible for 21% of operation. To reactivate and scale up the services disability adjusted life years(DALYs) for children for the early detection and treatment of child younger than 5 years due to diminished cognitive wasting it is important to analyze the socioeconomic 3 and physical development. determinants, anthropometric indices and nutritional Nepal’s commitment to improving nutrition is interventions of malnourished children. The outlined in the Multi-Sectoral Nutrition Plan objectives of the study are to classify malnutrition in II (MSNP) 2018–2022 and aims to reduce the children admitted in nutritional rehabilitation home prevalence of stunting to 28 percent and of wasting of Pokhara Academy of Health Sciences, to relate to 7 percent among children under 5, and to reduce the association of demographic characteristics and under nutrition (BMI < 18.5) to 12 percent among the nutritional status and to assess theeffectiveness women 15 to 49 years of age. For these objectives of the nutritional intervention measures on the status to be met, a coordinated multi-sectored, multi- of malnutrition of the children. stakeholder approach is instituted for a country- MATERIALS AND METHODS led, country-driven third phase of SUN (scaling up nutrition) Movement (2021-2025).Nepal This is a hospital based retrospective cross-sectional though having various constraints, has made some study in which total of 238 patients of severe praiseworthy changes in the past two decades. The acute malnutrition (SAM) and moderate acute prevalence of underweight has reduced from 42 per malnutrition (MAM) who were less than 5 years cent to 27 percent and child wasting from 15 percent old, were enrolled. The children were admitted in to 10 percent.1 Still the current stunting rate ishigh nutritional rehabilitation home(NRH) of Pokhara and we are far from our sustainable development Academy of Health Sciences, Western Regional goals which aim to end all forms of hunger and Hospital (PAHS, WRH) from 1st Shrawan 2071 to malnutrition by 2030.4 The prevalence of acute 32nd Aashadh 2075 BS (15th July 2014 to 14th July malnutrition is likely to be much more increased 2018). The study was conducted after the approval due to disruption in the functioning of food system of Institutional Review Committee of Pokhara and occurrence of global food emergency as a result Academy of Health Sciences (reference number of the current covid 19 pandemic. This current 2.2077/078). Inclusion criteria for study participants scenario has added a new and strong challenge to were weight for heightbelow -2SD with or without ~282~˷ Original Article Evaluation of malnutritionMedical in children Journal admittedof Pokhara in Academynutritional of rehabilitation Health Sciences home Vol.. Paudel 3 Issue G 2A. et. al. any grade of edema. Children who fall below minus cases, 3 cases were up to 6 months old, 124 (74.2%) two standard deviations< -2 SD to -3 SD from the belonged to 7 months to 2 years of age and 40 median of the reference population are regarded belonged to 2 to 5 years of age. Maximum numbers as moderately malnourished (MAM), while those of the cases (54.6%) were from Kaski district, who fall below minus three standard deviations<-3 followed by Tanahun, Syangja and Lamjung.Most SD from the reference population median are of the children (46.6%) stayed in the NRH for 15 considered severely malnourished (SAM).Children to 28 days. with chronic comorbidities (cerebral palsy, congenital heart disease, tuberculosis, thallesemia, Table 1: Socio-demographic characteristics of downs syndromeetc) were excluded along with malnourished children (n=249) At admission children, who stayed for less than 7 days in nutrition At admission Age Weight for height Weight for height rehabilitation home, children more than 5 years old, of the Per- (Z score)-2SDto-3SD No (Z score)<-3SD(SAM) Child- cent (MAM) who developed acute complications that required Fem ren Male Female Total Male Total transfer to intensive care or referral, children ale ≤ 6 14 5.9% 7 4 11 2 1 3 who were discharged against medical advice and months children with incomplete data.446 cases were 7 to 12 62 26% 12 16 28 19 15 34 admitted in the nutritional rehabilitation centre months of Pokhara Academy of Health Sciences from1st 13 to 24 Shrawan 2071 to 32nd Aashad 2075 BS (15th July 115 48.3% 19 6 25 40 50 90 2014 to 14th July 2018). During their stay in the months rehabilitation home, they were managed according > 24 47 19.8% 3 4 7 20 20 40 to the WHO protocol.5 Even though the discharge months criteria mandated weight for height of children to Total 238 100% 41 30 71 81 86 167 reach -1 SD, many children were discharged as per 57.7 42.3 29.8 48.5 51.5 70.2 Percent the request of the caretaker when they start taking % % % % % % Add- adequate amount of food.Out of the 446 admitted ress children only 238 cases were included in the study Gandaki 67 156 provi- 223 93.6% 37 30 76 80 according to the inclusion criteria and rest were 30% 70% nce excluded as per the exclusion criteria. Others 15 6.4% 4 0 4 5 6 11 The demographic factors and nutritional status Average Fe- Hospital Male Female Total Male Total during the period of initial stage (admission) and male at discharge was analyzed using available record of Stay anthropometry indicators.