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March 2009 - August 2009
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| The Emergency Ward and Nutrition Rehabilitation Centre's focus is to relieve the suffering of seriously malnourished children in West Bengal, India, and to work closely with families to help prevent malnutrition from occurring again. CINI's Emergency Ward provides emergency health care to children with acute malnutrition and related health problems. The Nutrition Rehabilitation Centre rehabilitates undernourished children and provides supportive care and training on nutrition and preventative healthcare to mothers. |
Last year (March 2008 - February 2009), 575 children received care and support at CINI's Emergency Ward and Nutrition Rehabilitation Centre. They were discharged after showing signs of gaining weight, and/or after their mothers were confident enough to return home to carry on with what they had learnt whilst in our care.
Achievements
- 92% of children discharged have received follow up support
- 80% of children receiving follow up support have been immunised compared to 56% - the average for West Bengal
- 81% of children have gone up a nutritional level
- We are working with local government representatives to make outcomes sustainable; they are helping with monitoring, and are also running supplementary feeding schemes
- We inform families about government income support schemes which are available to them
- Mothers have been taught about good nutrition and preventative healthcare, empowering them with the information they need to be able to care for all of their children
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We not only treat malnutrition, but prevent it |
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Follow up: six months on
After discharge, we were able to give follow up support to 92% of the children helped in the Emergency Ward or Clinic.
230 children were regularly visited at home by one of CINI's trained health workers. The remaining cases were from outside of CINI's project area, so follow up was done through their attendance at CINI's outpatient clinics. Of the total 345 children living outside of CINI's project areas, only 47 did not attend the outpatient clinics, making follow up impossible.
Children from outside the project area who had been severe cases were asked to come to the outpatient clinics for regular visits (initially weekly for a month, then fortnightly, and subsequently monthly) to ensure they were free from complications and to monitor their development. Moderate cases visited the clinic on a monthly basis to have their weight recorded and to receive further guidance on feeding, nutrition and childcare.
A few mothers asked for additional support from the nutritionist, as they wanted to revisit what they had learnt at the clinic. The nutritionist spent time explaining about how to provide a healthy, balanced diet from cheap locally available food. |
We teach mothers about good nutrition and hygiene
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Whether home visits or outpatient clinic visits were used for follow up, CINI staff monitored the children's growth, ensuring that mothers had enough support to be able to care for and feed their infants, and through parental counselling, encouraging both parents to take responsibility for ensuring that children receive timely immunisations.
As a result of the follow up done, the majority of children continued to gain weight. 81% have moved to a higher and better grade of nutritional status. Of the remaining 19%, many have improved, but not yet to a great enough degree to register as an improved grade of nutrition, or some have suffered illnesses or infections that have made it hard for them to absorb the nutrients from their food, setting back their progress.
80% of the children receiving follow up support have had their primary immunisations on time. This compares to an average of only 56% of children in West Bengal. Being immunised is particularly valuable for children who have been affected by malnutrition as this suppresses their immune system making it harder for them to fight off infections, so that even common childhood disease can be potentially fatal.
Some children who were not immunised were caught up by a wider problem which limited the supply of vaccines in their villages. Over coming months, we will be working to ensure that they too receive the immunisations they require.
The local panchayats (local self-government bodies) have been involved in monitoring all of the children admitted into our emergency ward and nutrition rehabilitation clinic through regular meetings with mothers, along with government health workers (from Anganwadi centres - government sponsored centres for mother and child care) and government nurses. We are working closely with them to ensure that improvements in the nutritional status of these children are made sustainable through ongoing support through the state system.
Background
Taslima was only 15 years old when her father gave her hand to 26 year old tailor, Safi. Within a year Taslima gave birth to a little girl called Nargis. However Safi had wanted a son, so when after three years Sahid their son was born, the couple were extremely happy.
From the beginning, Taslima struggled to produce enough breast milk. She would breastfeed Sahid three to four times a day along with another two feeds of formula milk. However, formula milk proved expensive for the couple, and so they exchanged it for arrowroot powder. Sahid became very sick. After a few months he developed skin lesions and was brought to CINI's clinic by his parents.
Taslima with Sahid lying on her lap suffering from Kwashiorkor - a virulent form of child malnutrition |
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Taslima, now a more confident mother, with Sahid on her lap, who is well on his way to recovery |
At the Nutrition Rehabilitation Centre
When Sahid first arrived at the clinic aged 5 months, he weighed only 12.1 lbs (5.5 kg). He was suffering from severe dermatitis and was diagnosed as having kwashiorkor - a virulent form of childhood malnutrition. Initially, Taslima was only concerned with her son's dermatitis and she told us, "There is poison in Sahid's body". After a counselling session, it emerged that Taslima had learned incorrect feeding practices and so had not know how to feed her baby properly. She was upset and complained that, "I don't have breast milk". It also emerged that an untrained rural medical practioner had encouraged her to take oral contraceptive pills straight after Sahid was born. The hormones from the pills made it difficult for her to breastfeed her child.
In CINI's care, Taslima was supported to be able to feed her child, and was taught different breast-feeding positions and the correct feeding intervals. She was also advised to stop taking oral contraceptive pills and to use other contraceptive methods until the child was weaned. Within a week she had enough breast milk to satisfy her baby. She began to feed Sahid seven to eight times a day, and he began to gain weight and his lesions began to heal.
Follow up
Sahid was discharged four weeks later, and a trained health worker visited him and his parents at home to monitor his weight and ensure that he continued to gain weight and receive necessary immunisations against preventable childhood diseases. Regular visits at home ensured that his mother continued to practice what she had learnt whilst in our care. Taslima has since been sharing this knowledge with other women in her community.
Since his return home, and on the advice of CINI's health worker, Sahid has been registered at a local government health clinic to benefit from the supplementary feeding programme that is available. He will now receive additional government healthcare support to improve his nutritional status.
Furthermore, his mother has been an inspiration to other mothers after speaking at a number of mother's meetings, and using her experience to encourage and inform other mothers how to make simple changes feeding and healthcare practices to manage and prevent malnutrition.
Thanks so much for helping to make this work possible!
See here for a printable version of this report (Word document)
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