Socioepidemiological determinants of severe acute malnutrition and effectiveness of nutritional rehabilitation center in its management

Background: Severe acute malnutrition (SAM) continues to be the reason for increasing hospitalization and also a major killer disease. Objectives: Identify socio-epidemiological determinants among both groups of SAM and evaluate impact of nutritional rehabilitation center (NRC) in its management. Methodology: A prospective observational study was conducted in a medical college on SAM children aged 6 months to 5 years over 1 year. Socio-epidemiological risk factors were compared in both groups. Therapeutic nutrition was provided as per World Health Organization guidelines. Serial weight monitoring and response criteria were analyzed at the time of discharge. Cases were followed up serially at 1, 2, 3, and 6 months for weight monitoring to assess long-term impact of NRC. Results: A total of 91 cases were enrolled; (Group 1: Group 2: 43: 48). Assessment of risk factors in SAM groups revealed a significant association between late initiation and lack of exclusive breastfeeding with group 1 SAM. Significant referrals (P : 0.001) from anganwadi centers included group 1 SAM. Majority responded to NRC management. Statistically significant weight gain noted at each follow-up in both types of SAM. At the end of 6 months, the recovery rate of group 1 SAM was statistically significant (P : 0.023), total defaulter rate was high (29.6%) and none had relapsed. Conclusion: Though NRC was effective in improving nutrition in SAM, results were not sustained in view of high defaulter rates at follow-ups. There is a need to improvise health education to caregivers, link NRC centers with community health centers for better follow-up and address modifiable socioepidemiological risk factors.