A single blinded, randomized control trial on improving adherence to treatment of Severe acute malnutrition by providing reminder calls.

1)    This is a single blinded 2 arm randomized control trial. After identifying the child as severely acute malnourished as per WHO criteria i.e. 1) Weight for height< -3 SD OR 2) Mid upper arm circumference <11.5 cm OR 3) Presence of bilateral pedal oedema of nutritional origin. Instrument like Electronic weighing scale, Infantometer, stadiometer, shakir tapes and WHO growth charts will be used for the anthropometric assessment of the patient. This assessment would be done by NRRTC staff nurse. NRRTC Medical officer would check for any medical complication as per IMCI protocol. If any complication is present the patient would be admitted in pediatric ward 21 and 22. If patient has no complication patient will be given appetite test.

2)      Management of Severe Acute Malnutrition:  Once the patient is enrolled into the program, the patient is started on Medical Nutrition Therapy (MNT). Medical nutrition therapy (MNT) is indigenous Ready to use therapeutic food (RUTF). RUTF is recommended by UNICEF and WHO for treatment of malnutrition. MNT consist of Sugar 28%, Peanut Paste 25%, Skimmed milk powder 24%, Vegetable oil 21%, Vitamins, Minerals, Emulsifier (HP1).

3)  After passing the appetite test, patient will be called to OPD on weekly bases for 8 weeks to 12 weeks  where he/she will be provided with MNT and patients anthropometry (weight, height and MUAC) would be monitored. After starting the patient on MNT, he/she would be enrolled in either Group A or Group B where Group A will receive reminder calls for the next scheduled visit and Group B will not receive any calls for the visit. Every subject will receive 16 calls maximum. After the enrollment, welcome call will be given. One day prior to the scheduled visit, one call will be done for the period of eight- twelve weeks (till the child is on MNT). After completion of MNT, one call a month will be given to remind about the follow-up for a period of 4 month. The contents in the call will include a) Whether they have continued taking MNT, b) How is the child doing, c) Any fresh problems, d) General guidance about breast feeding and infant young child feeding practises, e) Hygeine and sanitaiton. If the phone is not reachable or picked up, they will be given the reminder on the day of visit. Despite of phone calls if the patient does not visit then one more phone call will be done next day after the scheduled visit date.