India: Childhood Malnutrition Eradication Program

4,601 Villagers Benefited from Education and Counseling Sessions: Q2 2017

August 01, 2017
Rakesh Dhole and Deanna Boulard


Summary of Activities

  • Total rural tribal population in the 50 villages: 76,635
  • Total households in the 50 villages: 16,446
  • 36 meetings were organized with other stakeholders in the communities.
  • Follow-up visits and continuous education were provided to families whose child or children were suffering from severe acute malnutrition (SAM) or moderate acute malnutrition (MAM).
  • Our team continued implementation of RMF’s social enterprise model, based on findings from RMF India’s social enterprise survey of 50 local villages and knowledge gained from our 2014–2015 Adolescent Girls Outreach Program that covered schools throughout 3 districts of Madhya Pradesh.
  • RMF India’s leadership team held regular meetings with CNEs and district coordinators to provide key support and supervision of field staff.
  • RMF India’s leadership team made regular visits to field sites to provide key support and supervision of field staff.
  • RMF India’s office was duly maintained, and staff members were provided with salaries and wages on time.


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Results &

Accomplishments


  • Family Counseling Sessions

    3,466 Individuals Participated
    • 2,364 family counseling sessions were conducted by RMF India’s Community Nutrition Educators (CNEs).
    • 3,466 individuals (mainly women and adolescent girls) participated in the abovementioned family counseling sessions.

  • Community Education Sessions

    1,135 Individuals Participated
    • 177 community education sessions were led by RMF India’s CNEs.
    • 1,135 individuals participated in the abovementioned community education sessions.

  • Severe Malnourishment Cases

    Identification, Treatment, and Counseling Provided
    • 26 severe cases of malnutrition were treated and improved.
    • 41 new severe cases of malnutrition were identified for management, either within the community using service delivery platforms or in households, and/or referred to Nutrition Rehabilitation Centers (NRCs).
    • 20 severely malnourished children were admitted to NRCs after counseling.

  • Moderate Malnourishment Cases

    Identification, Treatment, and Counseling Provided
    • 55 moderate cases of malnutrition were treated and improved to normal nutritional status.
    • 113 new moderate cases of malnutrition were identified for management, either within the community using service delivery platforms or in households, and improved SAM to MAM cases.
    • 650 cases of moderate acute malnutrition (MAM) were followed by RMF India’s CNEs.

  • RMF Provides Jobs

    Improving Lives and Education

    Families of the CNEs that RMF employs as part of this initiative, many of whom are from the intervention villages themselves and use their salary from RMF to support their children’s education and to improve the lives of their families.


  • Counseling about Hygenic Menstruation Practices

    Reaching 20,000 Women and Girls
    • RMF India’s CNEs, trained as Swasthya Sahelis (Catalysts of Change) are working with approximately 20,000 eligible women and girls in 50 villages of Barwani block, speaking with them about menstrual cycles, working to dispel myths, and counseling the women and girls to adopt hygienic practices and use sanitary napkins.
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Background

& Objectives

Background

This project empowers communities through health literacy and connects rural communities with the government health and nutrition services available. This project aims to prove that a holistic, decentralized, community-based approach to malnutrition eradication will have better health outcomes, be more inclusive for children under 5, and will be more cost-effective in the long-run than centralized approaches, especially for rural, marginalized tribal communities. Our team of up to 75 Community Nutrition Educators (CNEs) and 6 District Coordinators has covered enormous ground across 5 districts and 600 villages in Madhya Pradesh.


Objectives
  • To reduce the prevalence of underweight children under 5 years old and to reduce child mortality from malnutrition by strengthening communities and village level government facilities’ capacity to identify, treat, and prevent malnutrition.
  • Continue to identify new SAM and MAM cases, refer complicated cases to the NRC and provide home-based counseling for all malnourished children
  • Refer 1,000 SAM children to government centers for treatment with a 50% success rate Quarterly
  • Conduct 2,500 Community Nutrition Meetings Quarterly
  • Conduct 9,000 Individual Family Counseling Sessions Quarterly
  • Send CNEs to Nutrition Rehabilitation Centers (NRCs) to help counsel families present
  • Continue to develop linkages with government health and nutrition services
  • Strengthen institutional capacity with support from World Bank’s India Development Marketplace Award.
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Numbers

Served

During this reporting period, in addition to the 4,601 villagers who benefited from education and counseling sessions conducted by RMF India’s Community Nutrition Educators (CNEs), 235 children suffering from acute malnutrition were identified and/or received treatment:

  • 154 new cases of moderate and severe malnourished children were identified.
  • 81 moderate and severe malnourished children were treated and their condition improved.
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Success

Stories

Vidhya

Age: 12 Months

Vidhya is a 12-month-old girl from the village of Bijasan in Barwani district of southwestern Madhya Pradesh, India. The village is 25 kilometers away from Barwani district headquarters and approachable by state highway. Most village families are engaged in agriculture, while others work on a daily wage basis. Vidhya’s mother works as a farm laborer in the fields.

Vidhya has seven members in her family: her father, mother, and four sisters. Vidhya is the sixth member of her family. Her father, Kishore, is 37 years old, and her mother, Rukma, is 34 years old.

On January 25, 2017, RMF India District Coordinator Deepmala Cholkar and CNE Mamta Awase found that Vidhya was suffering from severe acute malnutrition (SAM). Her mid-upper arm circumference (MUAC) was 10 cm. RMF’s Deepmala and Mamta discussed Vidhya’s history with her family. Her father, Rukma, explained that he has six daughters, and Vidhya is the small one. She was born at home and given initial breastfeeding within two hours. Her weight was 2.5 kg at birth. Vidhya received exclusive breastfeeding for six months, but due to the early next pregnancy of her mother, Vidhya has not been eating properly and was not started on complementary feeding after six months. She eats only cookies, toast, and snacks.

CNE Mamta explained Vidhya’s nutritional status to her parents and informed them about the causes and consequences of malnutrition. She then referred Vidhya to the Nutrition Rehabilitation Center (a medical and nutritional care unit that manages cases of severe acute malnutrition) at Barwani district headquarters. However, Vidhya was not admitted to the center because her mother had to take care of her other 5 children at home. She said, “Who will be taking care of them after me?”

Due to the family’s situation, and because Vidhya is 12 months old, CNE Mamta decided to facilitate the young girl’s recovery at home by providing counseling to her family on complementary feeding. She counseled Vidhya’s mother on complementary feeding and advised that the young girl be fed home-based, prepared breakfast food 2 times a day, a bowl of food 3 times a day, and breastfeeding as she requires. CNE Mamta also advised the mother to feed Vidhya supplementary foods provided by the Anganwadi center in the village. Vidhya’s mother agreed to feed her as CNE Mamta advised.

CNE Mamta has continuously followed up with Vidhya and her family whenever she visits the village and has given counseling to her mother on a balanced diet, hygiene and cleanliness practices, complementary feeding, and more. As of May 5, 2017, Vidhya’s MUAC has improved to 12.3 cm; now her nutritional status is classified as moderate acute malnutrition (MAM). CNE Mamta continues making follow-up visits and working to help Vidhya regain her health.

Effecting Change in Kasrawad

Bhagwati Bai’s Story

This is a story about change: change in the management of menstrual cycles in the tribal village of Kasrawad. The village is located in Barwani district of southwestern Madhya Pradesh, India, where RMF has started Real Medicine Enterprises, piloting a social venture to educate tribal women on menstruation and provide them with low-cost sanitary pads.

Bhagwati Bai is a 40-year-old woman living in a joint family in Kasrawad. Bhagwati always used a piece of cloth during her menstrual cycle. Because of this practice, she had to face many problems like rashes, infections, changing wet cloths more than twice a day, and fear of stains on her clothing. She didn’t know about sanitary pads. However, RMF India’s CNE Mamta Awase visited the village, met with Bhagwati, and counseled her on the use of sanitary pads during menstruation, making her aware of the benefits of pads and drawbacks of unhygienic cloths.

Bhagwati agreed to try sanitary pads, and she bought them from CNE Mamta at INR 25 for 7 pads, which is a low-cost and affordable price for rural women, as compared to market prices. Bhagwati started using sanitary pads in place of cloths, and now she feels comfortable and free from the problems that she previously faced during menstruation.

Now Bhagwati is happy, and she helps CNE Mamta to educate other tribal women and adolescent girls on the use of sanitary pads during menstruation. Today, most of the adolescent girls and women in the village are purchasing sanitary pads from CNE Mamta and using them. CNE Mamta has sold 32 packs of sanitary pads in Kasrawad to date, effecting positive change in the lives of the village women.

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