Thanks for appreciating the paper, raising some important issues and
seeking few clarifications. As stated in the paper, all children who
were admitted to the NRCs were examined by a physician to detect the
presence/absence of medical complications using the IMNCI criteria for
identifying medical complications. Children admitted in the NRCs also
underwent investigations (pathology, microbiology, radiology etc.) based
on their clinical condition and were treated appropriately along with
nutritional rehabilitation; 6.4% of children with medical complications
and 2.1% children with uncomplicated SAM were medically transferred.
NRCs protocols and training materials describe when to label a child as
a non-responder and the steps that need to be taken for such children.
This paper reports that more than half (58.2%) of the
children admitted to the NRCs had uncomplicated SAM and such children
should be cared for in a community-based program using good quality
ready-to-use therapeutic food. This recommendation is in line with a
number of references quoted in the paper. The reader would also
appreciate that the recommendation is in line with the recently released
Consensus Statement of the IAP and WHO.
The reader, would appreciate the limits of a ‘NRC
Only’ strategy; the paper mentions that of all the children discharged
from the NRC, only 25% came back for three follow-ups. A ‘survival 6
month or 12 month after discharge’ is a desirable performance indicator,
but such a tracking is possible with a community-based program where the
child can be followed up at home by a community worker and does not need
to come to the NRC.
