We began building Nutritional Rehabilitation Homes in 1998 as a way to restore severely malnourished children to good health while educating their caregivers about nutrition basics. Yet with half of all Nepali children suffering from malnutrition, we knew we would need the Nepali government to partner with us to create a sustainable solution for the problem.
Today, the Nutritional Rehabilitation Homes (NRHs) are a model of innovation and sustainability. We have built 16 of these small hospitals throughout the country, and the government is now operating eight of them. Together, we have helped more than 20,000 children and have educated their parents about low-cost nutrition strategies.
It's a win-win program. We build the NRH’s, hire and train the staff, and help the hospitals develop a successful operating plan. After five years, we hand over management of the NRHs to the government, freeing up valuable resources so we can continue to build new facilities — such as the NRHs we're building in Baglung, Dang and Butwal.
When you meet the children we serve, you appreciate the miracles that happen at the NRHs. Jal Bahadur is one of the children who got a new start in life at an NRH. Last April, NYF workers found him during a Nutrition Outreach Camp. His mother had died four months earlier, and his deeply impoverished father struggled to care for Jal and his older sister. Three-year-old Jal was so malnourished he could not talk, walk or even stand up.
Within 20 days of care at the center, Jal had gained weight and regained enough strength in his legs to walk. His father learned the basics of good nutrition and took this information back with him to share in his rural village.
While poverty is pervasive in Nepal, the simple lack of knowledge about good dietary practices is often the cause of child malnutrition. NRH nurses and nutritionists teach parents to prepare food that is affordable and locally available. The families return home with a healthy child and the knowledge they need to keep all of their children growing strong.
Thanks to your support, children like Jal have a chance to lead a healthy life.
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Nutritional Rehabilitation Home staff discovered Jal C. in April 2013 during an outreach camp in rural Nepal. The 39-month old boy was so malnourished he could not stand, walk, talk or eat properly. They enrolled him and his father in the NRH and the youngster recovered after only 20 days.
Jal is from an extremely poor family in the rural hills of Nepal. His mother died last year and his father cares for Jal and his seven-year-old sister. As part of the NRH training, Jal's father learned how to prepare low cost nutritious food for his children and to practice good sanitation. He was able to go back to his village and share this knowledge with his neighbors.
Last year, 1,178 children received care in the eight NRHs under NYF managment. More than 80 percent of these children were under age 5. At the same time, 1,073 caretakers learned about food, nutrition, health, hygiene and sanitation in the training sessions.
NYF builds the NRHs on the grounds of existing hospitals. After the clinics are operational for five years, NYF turns them over to the Nepal government, while NYF continues to oversee the operations.
We continue to be deeply grateful for your support of the NRH program and, especially, when we can save a child like Jal from starvation. Please give as generously as you can, so that we can continue to help children in Nepal grow up to live as fully as possible.
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Project Update: July 2012 – March 2013
With the help of generous donors like you, NYF's Nutritional Rehabilitation Homes have been able to provide lifesaving treatment for over 8000 dangerously malnourished children. The work done by the NRHs not only treats individual children, but also educates the parents to promote the long-term health of the child. Training for health care workers around the country further helps to reduce the terrible prevalence of childhood malnourishment.
Rehabilitation:
From July 2012 to March 2013, 153 malnourished children were admitted to the NRH in Kathmandu. During the same period, 144 children were discharged afterbeing returned to health. Field supervisors conducted 278 follow-up visits. 256 of the children were found to be still in good health. The cases of relapse were caused by medical complications and poverty.
Education:
While the children were receiving residential care, their mothers took part in training relating to food, nutrition, hygiene, and sanitation. 50 of the caretakers were unable to stay at the NRH, and were given counseling about a balanced diet.
Vaccination:
Some of the children who come to the NRHs have not yet been given basic childhood vaccines. At the NRH in Kathmandu, 22 children were vaccinated against tetanus, 32 were vaccinated received the MMR vaccine, and 42 received a meningitis vaccine.
Outreach Camps:
In the reporting period, NYF conducted four outreach camps. Out of 1302 children screened, 500 (38.4%) were found to be malnourished. Nutritional information was provided to the caretakers, and severe cases were referred to the NRH for further treatment.
Training:
In addition to directly working with malnourished children and their guardians, NRH - Kathmandu provides training to health care professionals. During the reporting period, 23 professionals were trained.
The training was executed in three phases. In the first phase, a ten-day training program was conducted focusing on four major components: basic knowledge on nutrition, diet management for specific age groups and physical conditions, diet management of patients with specific diseases, and management of acute and chronic malnutrition.
In the second phase, the participants returned to their jobs and implemented the knowledge they had acquired. Experts involved in this project then carried out follow-up visits and met with hospital managements to ensure effective implementation of the training.
The third phase consisted of a 5-day refresher training.
The trained professionals are now focusing on promoting health through diet counseling, nutritional awareness, and improvement in kitchen management and cooking in hospitals. They are also sharing of their knowledge with other professionals on their team, multiplying the effect of the training.
Case Study: Mahendra
Mahendra was severely malnourished when he came to the NRH in Kathmandu. At 9 months, he was being fed solely on breast milk. Unfortunately, his mother was not producing enough milk. When he arrived at the NRH he weighed just 7.5lbs – 70% below a healthy weight. After 35 days, he had recovered the lost weight and was discharged a healthy, happy 11lbs 11oz baby.
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Expanding
The NRHs are located in 12 districts throughout the country. The total capacity of 12 NRHs is 143 beds. With an average of 30 children staying days and a ninety percent occupancy target, these NRHs have a capacity to serve 1570 malnourished children per year. NYF is currently managing 7 NRHs with 84 beds capacity. Four new NRHs are underway in Baglung, Dang, Butwal and Dailekh.
Two week long intensive training sessions for the staff of NRH-Bharatpur (recently established on April 27) was conducted by the experts from Kathmandu NRH. All the NRHs are operated in the same model of the Kathmandu NRH and hence, Kathmandu NRH has been acting as a resource and training center for the outlying NRHs. An orientation was also organized in Bharatpur in which representatives from District Health Office, local health posts, doctors, nurses, and other medical personals were invited. The purpose was to expand network and disseminate information about the NRH and its working modality amongst the associated people and institutions.
Nutritional Outreach Camp
NRH Kathmandu conducted two Nutritional Outreach Camps in these 6 months: 609 children were screened out of which 432 (71%) were found to be in normal health condition and 29% were malnourished. Education on nutrition and health was provided to the mothers/guardians of the children, especially those with malnutrition. The severely malnourished children were referred to the NRH for further treatment.
Within the 7 NRHs under NYF, 490 children, 278 boys and 212 girls, were admitted and provided nutritional care. Among them 88% (431) belonged to age-group under 5.
Likewise, 519 children (277) male and (242 female) were discharged: 387were discharged officially after they reached normal weight, 81 were discharged on request, and 38 were referred to the hospital and 13 left against medical advice.
460 care takers were trained about food, nutrition, health hygiene, and sanitation through demonstrations and practical sessions.
939 follow-ups were carried out and most of the children’s health conditions were found to be satisfactory. Few children were still malnourished due to poor economic condition and/or chronic medical complications. 12 death cases were also reported in this period which is quite high as compared to other times.
NRH Kathmandu provides vaccination to those children who did not have chance to receive necessary vaccines prior to their arrival at NRH. During this quarter, 14 children were administered TT, 23 were administered MMR and 30 children received vaccine against Meningitis.
In coordination with the hospital and District Public Health office, NRH-Surkhet has started to provide immunization services to the children of Surkhet and adjoining districts. The addition of this facility has made it easier for the people to know about our facilities when they bring their children for vaccination and we have been able to identify and treat more children as a result.
For those parents who were unable to stay at the NRHs, counseling was provided on feeding appropriate balanced diet to recover the weight of the child. These counseling sessions have proved to be quiet effective as majority of the guardians reported good improvement in their children.
In case of the 5 NRHs which are handed over: 282 children were admitted and 275 mothers/caretakers were educated in nutrition and health in these 6 months.
Dietician Training for Health Professionals
The highly positive outcome from the previous Diet Management Training (especially for staff from zonal hospitals) encouraged us to give continuity to this project and hence, a 2nd training was conducted (September 23 - October 2, 2012), this time aiming to build the capacity of the district hospitals.
The core components of the training were:
After the completion of the 10 days training (1st phase), the trainees went back to their workplaces. The Manager of the Kathmandu NRH and the Nutrition Coordinator for Nepal Youth Foundation (NYF) then carried out follow up of the participants in their respective workplaces. The follow up showed that the participants were effectively implementing the training content in their workplaces (hospitals and NRHs) through sharing of the training content with the hospital management team and the staff, displaying posters and other information on diet and diseases in hospitals, diet counseling for patients, menu preparation for patients and improving the management of the hospital kitchen.
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The Nepal Youth Foundation’s Nutritional Rehabilitation Homes are located in 12 districts throughout Nepal. They have a total capacity of 143 beds and this year they treated 1,697 severely malnourished children and provide hands-on training to 1,561 mothers in nutrition and health. Countless lives are saved by this program, and even more children are rescued from being physically or mentally stunted for life.
The Nepal Youth Foundation builds the Nutritional Rehabilitation Homes (NRHs) on the grounds of government hospitals and gets them up and running, then transitions management of the Homes to the government five years later. Two NRHs were handed over to the government this year, making a total of five that are now being run by the government, leaving the Nepal Youth Foundation (NYF)’s funds available for building new NRHs.
In the last year, NYF’s staff investigated three more government hospitals and determined they are suitable locations for buildng new NRHs.
NYF built a new flagship NRH in Kathmandu, which was inaugurated on February 21, 2012 and started operations on April 27, 2012. It has 24 beds and a large room for training. The training facilities have already been used for training new NRH staff as well as dieticians and other health professionals from throughout Nepal.
In addition to treating children at the Kathmandu NRH, the staff conducted three nutrition outreach camps in underserved areas. They conducted growth monitoring for children and provided health education to parents.
Thanks to generous support from donors, the NRH program continues to thrive.
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