Managing child malnutrition in a drought affected district of Rajasthan--a case study.

Rajasthan is the largest state in the country frequently affected by droughts. The year 2002 happened to be the fifth consecutive year of drought. Almost all districts of the State were hit by it. The district of Baran located in South-East of Rajasthan has 'Sahariya' tribal population concentrated in its Kishanganj and Shahabad blocks. Press reports of starvation deaths amongst tribal children in these blocks created a stir in the local district and the State Government set ups. The paper describes an objective and professional approach to deal with the situation. Rapid nutritional assessment indicated very high prevalence of severe under weight (28.3%) and wasting (4.7%) amongst under five children. Nutrition Care Centres (NCC) were set up in selected villages to provide targeted feeding and care to these children as per WHO guidelines. Local 'Sahariya' community was involved to run these NCC. Intensive public education campaign was carried out to promote improved child caring practices and referral of malnourished children with complication to hospitals. Orientation of press and electronic media on factual details regarding the situation helped create an enabling environment to implement remedial measures. The impact of 'Nutrition Care Centres' assessed after six months was found to be positive in terms of reduction in prevalence of under nutrition in children from 66.7% to 59.6%. Successful management of severe malnutrition amongst children by workers at Nutrition Care Centes and in family settings using standard protocols led to the wide scale replication of the approach by Anganwadi centres in different district of Rajasthan. The State Government also created an additional cadre of worker called 'Sahayogini' to support Anganwadi worker and promote better child caring practices at family level.

As caracteristicas nutricionais sao fatores de risco para desenvolver diarreia complicada por desidratacao moderada a grave / Are nutritional characteristics risk factors to develop dehydrating diarrhoea?

A doenca diarreia persiste como uma causa importante de mortalidade de criancas menores de cinco anos, especialmente para paises em desenvolvimento. Apos a implantacao da terapia de reidratacao oral houve reducao da mortalidade, especialmente devido a diarreia aquosa aguda. Contudo estima-se que 2 a 3 por cento dos episodios de diarreia evoluam para desidratacao e choque, representando a causa de obito para aproximadamente 22 por cento das criancas menores de um ano. Investigaram-se os fatores associados ao risco de desenvolver diarreia complicada por desidratacao moderada ou grave atraves de um estudo de casos e controles, conduzido na area metropolitana de Porto Alegre, Os casos eram de criancas menores de dois anos com diarreia aguda hospitalizadas por desidratacao moderada ou grave. Os controles constituiram-se de criancas sem diarreia, residentes na mesma vizinhganca e do mesmo grupo etario dos casos. Identificaram-se fatores de risco socioeconomicos, ambientais, maternos reprodutivos e de assistencia a saude da crianca. Destacam-se como fatores de risco independentemente associados as exposicoes a idade menor do que quatro meses e, poara as criancas acima de um ano, idade menor do que dezoito meses; baixo peso de nascimento, substituicao do leite materno por leite artificial e menor tempo decorrido apos a suspensao do leite materno