Smriti Irani launches protocol for identification, management of malnourished children at anganwadi level

New Delhi: Severe Acute Malnourished children without medical complications will be managed at anganwadi centres instead of nutrition rehabilitation centres, according to the 'Protocol for Management of Malnutrition in Children' launched on Tuesday.

The standardised national protocol has been drafted by the Centre to provide detailed steps for the identification and management of malnourished children at the anganwadi level. The protocol was launched by Union Women and Child Development Minister Smriti Irani.

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According to the protocol, SAM (Severe Acute Malnourished) children with medical complications, presence of bilateral pitting oedema and/or failed appetite test will be enrolled in the NRCs.

Bilateral pitting edema refers to swelling in both legs, or occasionally in both arms, that is characterised by an indentation, or ''pit'', that remains when pressure is applied to the swollen area.

A Nutrition Rehabilitation Center (NRC) is a unit in a health facility where children with SAM are admitted and managed. Earlier, all SAM children were admitted to the NRCs, according to the protocol.

So far, a majority of NRCs have been managing SAM children of six-59 months but these centres will now extend services to infants aged one-six months with severe malnutrition or severe nutritional risk.

According to the protocol, every SAM child who passes the appetite test and all severely underweight (SUW) children shall be screened by the medical officer of primary health centres within three-five days of the test to identify any health issues, hidden infection or danger signs.

Children with any medical complication should be referred to the nearest health facility for medical management and further treatment of sickness, it said.

The protocol said infants less than six months of age, who are visibly wasted or oedematous or too weak or feeble to suckle, should be immediately referred to the nearest health facility or NRC for evaluation and treatment by ASHA/AWW/ANM.

Further, severely underweight children of up to six months should also be referred to NRCs directly for further management as per WHO guidelines, the protocol said. Irani said that out of over seven crore children evaluated at anganwadi centres, as many as seven per cent were found to be severely acute malnourished.

She also said 42,000 mini-anganwadi centres have been converted into anganwadi centres and that all equipment at these centres would be refurbished every four years.

The protocol said the identification of malnourished children should be done using growth monitoring data (weight-for-height and weight-for-age).

After the identification of children using growth monitoring data, appetite tests shall be carried out by the AWW for all SAM children in order to assess for the presence of medical complications, according to the protocol.

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