NUTRITIONAL REHABILITATION CENTRE

DR. VIKRANT KABIR PANTHI

1ST YEAR RESIDENT
DEPARTMENT OF COMMUNITY MEDICINE
NSCB MEDICAL COLLEGE JABALPUR M.P
EMAIL:- vikrantkabirpanthi@yahoo.com
Introduction :-

The Nutrition Rehabilitation Center (NRC) is launched under

collaborative scheme of UNICEF and Govt. of India.

It is a unit for restoring severely acutely malnourished (SAM)

children to good health while educating their mothers about
nutrition and child care.
The mother is provided with accommodation, food and
emotional support as her child is nursed back to health.

When mother and child return to their village,

the mother shares her new knowledge with her family and
neighbours.
NRC was started in 2005 as an implementation under
Integrated Child Development Scheme (ICDS)

NRC are located at PHCs or CHCs

Aim :- To improve the nutritional status of 3rd & 4th grade

malnourished children on a sustainable basis

Strategy: - Keep mother & child in NRC for 2‐3 weeks and to
train mother in child care & feeding practices
MAJOR FEATURES :

Strength: May vary according to the setup of hospital.

NRC at Jabalpur Medical college is 20 bedded.

 Mother or local guardian (Primary care giver) will be accepted with the client.

 In case of orphan child, care giver may be hired for supporting the baby for the entire
period of stay in the Nutritional Rehabilitation Centre.

 In above case honorarium may be paid from RKS ( Rogi Kalyan Samiti) to the Care giver .

Period of Stay :
 As recommended by treating Physician & Nutritionist-cum-Counselor.

 Usually it is of 14 days.

.
Services to be provided at NRC :

 Treatment &Patient management.

 Nutritional support to inmates. Nutrition education to his/her family
members.
 Other counseling services viz. Family planning, Better hygiene practices,
Psycho-social care & development.
 Capacity building of the primary care givers on Preparation of low cost
nutritious diet from locally available food ingredients,
 Developing Feeding habits & time management in mothers, imparting
knowledge of developing kitchen garden etc.
 Follow up Services

TYPES OF Nutritional Rehabilitation Centre:-
NRC
DAY CARE NRC
 Similar to crèche or kindergarten
 Children spends 6-8 hrs daily for 6
days a week in these centers &
take 3 meals each day.
 Mother may attend centers & help
preparation of meals or may attend
weekly meeting at the centre
RESIDENTIAL NRC
 Larger staff and equipments than
day care NRC.
 Children and their mothers live in
these as inpatients for 14 days or
more.
 They are more popular and
widespread in our country.
Incentives given at NRC :-
 During Stay :-
To Mother DA :- 65 Rs./ day X 14 days = 910 Rs.
Transportation charges = 200 Rs.
Total = 1100 Rs.

To AWW who brings the child Rs. 100/-

 During Follow Up :-

To Mother Rs. 65. + Rs.200 as transportation charges

To AWW Rs. 100

 ADMISSION CRITERIA :-

AGE CRITERIA
Infants < 6 months or The infant is too weak to suckle effectively independent of his/her Wt.
< 3 kg being breast for length ( if this is due to acute illness that has to be treated 1st)
fed. OR
The infant is not gaining weight at home (by serial measurement of
weight during growth monitoring)

OR
Presence of bilateral pitting edema

Children between 6 Wt/ Ht. or Wt/L < -3 Z scores (WHO 2005 Standards)
months – 60 months
of age AND/OR

MUAC (Mid Upper Arm Circumference) < 115 mm

AND/OR
Presence of bilateral pitting edema.
 DISCHARGE CRITERIA

AGE CRITERIA
Infants < 6 months or It is clear that he/she is gaining weight on breast milk alone after
< 3 kg being breast fed supplemented suckling technique is being used.
AND
There is no medical problem (no edema for 7 consecutive days,
no infections)
AND
The mother has been adequately trained.

Children between 6 Target wt. gain achieved (i.e. 15% Wt. gain from the Wt. on
months – 60 months admission)
of age AND/OR

No Edema for last 7 days in facility based care & for last 14 days
in programme
AND/OR
No Medical Complications.
 ROLES AND RESPONSIBILITIES OF NRC
STAFF
Position Roles & responsibilities

ADMO(Med)-cum-Nodal officer -Over all In -charge of the center. He / She will take day
to day administrative decisions regarding the center.

-He will be the drawing and disbursing officer for the

center.

Hospital Manager-cum-NRC -He will support ADMO (Med) in managing the

Coordinator Center.

--He / She will coordinate / supervise day to day

activities and report to authorities accordingly.

-Coordinate with hospital and other agencies for

ensuring essential services.
 Nutritionist cum Counsellor - Plan food and nutrition programs and supervise the
preparation and serving of
Meals.

-He/She Promotes healthy eating habits and

recommends dietary modifications.

-He/She assess patient’s nutritional needs, develop and

implement nutrition programs and evaluate and report
the results.

-He counsel family members on nutritional practices

designed to prevent disease and promote health.

Medical Officers -Attend cases at least once in a day.

-Attend emergency calls as & when required.

 -Anthropometric measurements.
Health Worker (F)
-Provide treatment under the supervision of the
physician.

-Nutritional counselling.

-Attend cases as & when required.

-Help in maintenance of records.

-Willing to work on rotation & at night shift.

Cook -Cook food for inmates.

Attendant -Responsible for housekeeping & maintenance of

cleanliness in the home.

-Help in cooking foods for inmates.

-Develop Kitchen garden in the premises.

 SCREENING TRIAGE
APPETITE TEST (Done by offering Therapeutic feed )
PASS FAILS

Direct admission to Direct admission to

Phase 2 in NRC Phase 1 in NRC

Fails appetite test or Phase 1 Inpatient

Phase 2 Treatment in NRC
devlops complications treatment using F-75 diet
using F-100 Diet and TF
based on proteins and
calories recommended in Return of apetite or reduction of
IAP 2006 Edema

Transition phase T/t or F-100 Diet

Discharge to follow up by AWW

4 Follow Ups at 15 days interval at NRC

 Therapeutic feed
Ingredients:-

 Roasted Groundnut - 1000 gm

 Milk powder - 1200 gm

 Sugar - 1120 gm

 Coconut oil - 600 gm

This feed is used to do appetite test as well as it is given simultaneously

with other feeds to child as per the diet plan during his entire stay at
NRC.
 How to prepare
 Take roasted groundnut & grind them in mixer.

 Grind sugar separately or with roasted groundnut.

 Mix groundnut, sugar, milk powder & coconut oil.

 Store them in air tight container.

 Prepare only for 1 week to ensure the quality of feed.

 Store in refrigerator.
HOW TO DO THE APPETITE TEST :

 Do the test in a separate quite area.

 Explain the procedure of the test to the mother

 The mother is made to wash her hands.

 The mother sits comfortably with the child on her lap and offers the
therapeutic feed.
 To pass the Appetite Test the intake of test meal has to be
at least in moderate range.

Reference table :- ( Body weight in kg Vs Intake in grams)

BODY WEIGHT POOR MODERATE GOOD

3 - 3.9 <15 15 – 20 >20

4 – 5.9 <20 20 - 25 >25

6 – 8.9 <20 20 – 30 >30

7 – 7.9 <25 25 – 35 >35

8 – 8.9 <30 30 – 40 >40

9 – 9.9 <30 35 – 45 >45

10 – 10.9 <35 35 – 50 >50

12 – 14.9 <40 40 – 60 >60

 F-75 FEEDS
( Given to the child in Phase- 2 treatment)

 Milk – 28 ml. = ¼ bowl

 Sugar – 6.5 gm = 1 ½ teaspoon

 Murmura – 3.5 gm. = 2 ½ teaspoon

 Veg oil – 2 gm = ½ teaspoon

Energy – 75 Kcal
Protein – 1.2 gm
Lactose – 1 gm
 F- 100 feed
( Given to the child in Phase- 1 Treatment)

 Milk – 90 ml. = 1 bowl

 Sugar – 5 gm = 1 teaspoon

Veg oil – 2 gm. = ½ teaspoon

 Water to make total vol 100 ml

Energy – 100 Kcal

Protein – 2.9 gm
Lactose – 3 gm
 Medicines to be administered at NRC
 Vit A :- 6-11 months of age – 1 ml.
>12 months of age – 2 ml

 Folic acid -5 mg on day 1 & then 1 mg/day on subsequent days at NRC.

 Zinc- 2mg/kg/day

 Iron- Start on 7th day with 3 mg/kg/day

 Potassium (Potklor syrup)- 3-4 mmol/kg/day

 Magsulfate [50% w/v]- 0.4- 0.6 mmol/kg/day

 Antibiotics:- As per requirements.

 Measles vaccine if not vaccinated

A malnourished
After treatment at NRC
child before
and Follow- ups
admission to NRC
Severly malnourished After treatment at NRC
child before and Follow- ups
admission to NRC
NRC at NSCB Medical college Jabalpur
[ Deptt of Pediatrics]
THANK YOU