NRC 2 heevi hospital

2. 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.

3. • 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

4. 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.

5. 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.

6. 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

7. 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

8. Actions for progression ??
Only two steps

10. Lecture on Malnutrition

11. 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 ??

12. 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.

13. THANKS FOR YOUR
PATIENCE….