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Indian Pediatr 2012;49: 842
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Widening the Spectrum of Services Delivered by
the NRC
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Ruchie Gulati
Specialist Paediatrician, Sardar Vallabh Bhai
Patel Hospital, Delhi, India.
Email:
[email protected]
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The recent Perspective by Prasad, et al.
[1] was indeed an interesting and thought provoking article
highlighting the issue of managing/preventing and treating malnutrition
other than severe acute malnutrition, to be benefitted by the Nutrition
rehabilitation centers. It highlights clearly the defined roles of ASHA,
AWW and PHCs in managing the larger goal of malnutrition
prevention/treatment.
I believe that although secondary/tertiary care
hospitals may be targeting management of undernourished children other
than severe acute malnutrition optimally, this may not be so at other
places where NRC/IYCF are functioning, possibly in the outreach. Just as
we have defined guidelines for management of varied multifactorial
illnesses as ARI or Asthma, it would indeed be need of the hour to
integrate updated comprehensive guidelines/protocols for the management
of stunting, moderate malnutrition, growth faltering and acute weight
loss needing urgent attention, also by special nutritional counseling;
imparting specific knowledge about locally formulated energy dense, home
based foods; identifying who and when to investigate; along with
specific follow-up and monitoring at prescribed intervals.
While the NRC guidelines do observe and note the
presence of undernutrition, the treatment focus is on the treatment of
SAM (which undoubtedly requires urgent attention). The IYCF services
wonderfully focus on the issues of exclusive breastfeeding, timely
introduction of complementary foods while handling feeding problems, and
complementing mother’s knowledge about the right quantity and quality of
foods. Though it would be a challenge to address the complex spectrum of
various types and degrees of undernutrition, I would strongly believe
that such an addition/improvisation in the protocols possibly in the
already established NRC may augment the services delivered and have a
huge impact on the prevalence of large spectrum of undernutrition.
Widening of spectrum of services delivered by the NRC may have logistic
implications, but it would be worthwhile for a holistic approach
targeting undernutrition.
References
1. Prasad V, Sinha D, Sridhar S. Falling between two
stools: Operational inconsistencies between ICDS and NRHM in the
management of severe malnutrition. Indian Pediatr. 2012;3:181-5.
2. Operational Guidelines on Facility Based Management of Children
with Severe Acute Malnutrition. New Delhi: Ministry of Health and Family
Welfare; 2011.
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