Dr.Azad A Haleem AL.MezoriDCH, FIBMS

Lecturer University Of Duhok

Faculty of Medical ScienceSchool Of Medicine-Pediatrics Department

2015azad82d@gmail.com

Nutrition Rehabilitation Centers in Heevi Pediatrics Teaching

Hospital/Duhok

Background

• (NRC) is a unit in a health facility where children with (SAM) are admitted & managed.

• according to Fourth Round of the Multiple Indicator Cluster Survey (MICS-4) :

• the severe wasting in Kurdistan region is 2.6% so the estimated cases of SAM in Duhok province will be up to (4680) under five children

• and up to (400) among IDPs depending on Nutritional survey among IDPs in Duhok province in September-November 2014.

• Admission: per defined criteria : • (Weight-for-Height Z-score <-3) • (Severe wasting. Oedema. Dermataosis. Eye

signs)• Objectives: • medical & nutritional therapeutic care. • improving the skills of mothers on complete

age appropriate caring & feeding practices.

Background

NRCs in Heevi Hospital

• As the bulk of refugees and IDPs in Iraq and Kurdistan are in Duhok province so the reactivation of NRCs in Duhok was one of urgent needs.

• We start to activate the unite after Training course on malnutrition on 13/4/2014 in Duhok .

• after the discontinue UNICEF support and sustainability of the therapeutic milk interrupted, the NRCs became inactive.

Mechanism of work

o Unit: not separated ?o Referral : pediatricians inside the hospitals or

private clinic’s or refer by PHCs.o Supervisor: only one pediatrician is trained on

WHO guidelines of treatment of SAM cases.o Assistants: mainly mother in addition to SHO

& nurse.

o Nutritional side of management: Milk: Nutritional side of management was depended on

the availability of therapeutic milk F75 and F100 (their availability was not sustained)

• we can not prepare it inside the NRCs. folic acid and multi-micronutrient , Iron and Vitamin A now

available. Antibiotics: Ampicillin and Gentamycin parentrally and

then Bactrium oral because of Diahhrea by Amoxil.o Follow up: Plumpy (Nut, Doz, Sup) was used for out pationt

followup.

Mechanism of work

Data analysis

• Till October 2014 both milk were available.• From that time I did not admit any patients • We treated 49 patients • 20 of them till now on follow up with

complete cure. • Six of them died

Actions for progression ??

Only two steps

Lecture on Malnutrition

Obstacles • 1. Lack of sustainability of supplying therapeutic milk 75, F100. • 2. Poor referral and feedback system between PHC centers and

NRC units. • 3.Wrong referral? Like referral of patient with organic causes

like C.P? • 4. NRC hasn't typical engineering design and equipment,

nursing station, kitchen, storage space, bathrooms &toilets . • 5. Overcrowding in main hospitals.• 6. Overburden up on pediatricians, each one of them has

many tasks and duties.• 7. no active staff ??

Recommendations • 1. Involving more than two pediatrician and 4 paramedics .• 2. Sustainability in supplying of therapeutic milk F75 and F100. • 3. Building the ideal NRC complex or unit in Heevi including all

necessary rooms like a patient area, play & counselling area , audiovisual equipment like TV, DVD player, nursing station, kitchen, storage space, bathrooms & toilets .

• 4. participation in active and practical management unit in one of the country with good SAM management outcome.

• 5. Strengthening of referral and feedback system between PHCs and NRCs.

• 6. Providing special types of formula for treatment of cases of lactose intolerance and other conditions.

THANKS FOR YOUR PATIENCE….