The purpose of this Operational Guideline is to support state health authorities, programme managers and health care professionals with recommendations on appropriate management of children with SAM in the health facilities. Facility based management includes setting up and managing within the healt...h facility premises, a functional space where these children are cared for. This Facility Based Unit is referred to as Nutritional Rehabilitation Centre or NRC in the document. While the scale and design may vary in a given situation, it is intended that the document provide the basis for a consistent set of principles that can be used by all states for facility based management of children with SAM. The Operational Guideline focuses on the Facility/Hospital based approach for the management of SAM children under 5 years of age based on the WHO and revised IAP protocols.
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2nd edition. Children with TB comprise about 10-12% of the total TB cases diagnosed in the country. This burden is likely to be higher given the challenges in diagnosing TB in children. The symptoms of TB in children mimic those of other childhood diseases. Children do not readily expectorate and th...ey have pauci-bacillary TB hence some will be missed using bacteriological tests. The government has however introduced GeneXpert molecular testing that is more sensitive than microscopy in detecting TB. Health care workers therefore need a reference guide to obtaining sputum from children for testing. Treatment of TB in children has been reviewed and now includes Ethambutol. There are now improved paediatric friendly TB medicines for treatment of TB in children and health care workers need a reference guide to enable them accurately dispense the TB medicine to children. Malnutrition is a common predisposing factor for TB in children. On the other hand, TB predisposes children to malnutrition or worsens an existing state of malnutrition. Nutrition care and support forms an integral part of treatment for a child with TB disease.
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