India: Childhood Malnutrition Eradication Program

Ankita

Severely Malnourished Child

This story takes place in the village of Bijasan, located 25 kilometers away from Barwani district headquarters in the West Nimar region of Madhya Pradesh, India. The village, like this entire region, is predominantly tribal and inhabited by Bheel and Bhilala communities. Bijasan has a population of 1,385, and most people there engage in work related to farming and labor associated with it. As part of governmental service delivery, there are 2 Anganwadi centers, a primary school, and a health sub-center located in the village. The distance to the nearest Nutrition Rehabilitation Center (NRC) is 25 km; it is located at the district headquarters.

Ankita is a 12-month-old girl who belongs to the Bhilala community. Her family includes her 26-year-old father, Vinod, and her 23-year-old mother, Punam. The family’s economic status is below the poverty line. Ankita’s parents are daily wage earners, whose meager earnings help cover the household expenses one way or another.

This village is within Real Medicine Foundation’s malnutrition prevention and management program coverage area. RMF’s Community Nutrition Educator (CNE) assigned to the village conducts home visits as part of her responsibilities, screens children for signs of malnutrition, and helps manage moderately and severely malnourished children in cooperation with government front-line community workers, Anganwadi workers, and others. During one such recent routine field visit on January 5, 2017, RMF’s CNE screened Ankita for malnutrition. It was distressing that the child’s mid-upper arm circumference (MUAC) was found to be 11.2 cm, indicating that she was severely malnourished. Worried, the CNE wanted to determine what had led to Ankita’s case becoming so severe.

The CNE was told that Ankita was born at home and weighed 2.5 kg at birth. Ankita was not breastfed immediately after birth. Her mother started breastfeeding her the day after, continuing up to 9 months. She was also given jaggery water. Beyond her 10th month, Ankita was given complementary foods, such as cookies, toast, and finger chips, etc. She was becoming ill because her mother wasn’t aware of the right time and method of starting complementary feeding for the child. The CNE was also told that Ankita suffered from recurring episodes of diarrhea. The result was that by the time she was screened, Ankita had reached a state of severe malnutrition and looked thin, pale, and weak.

RMF’s CNE shared Ankita’s case with the concerned Anganwadi worker, and they both reached out to the family and provided counseling, which included their recommendation for the immediate referral of the child to a Nutrition Rehabilitation Center (NCR) for the proper care and support that she required. The family was also made aware of the services the NRC would provide, which would also partially offset the wage loss that the family would suffer during Ankita’s stay at the NRC. The CNE and Anganwadi worker’s repeated sessions of joint counseling and persuasion helped to address family’s fear and inhibition about taking Ankita to the NRC. The family also received assurance from these two Swasthya Sahelis (Catalysts of Change) that their food and stay at the NRC would be taken care of. However, Ankita’s father still would not agree to take the child to the NRC.

The CNE and Anganwadi worker then decided to treat Ankita at home. RMF’s CNE counseled the mother to properly feed her child with nutritious foods four times a day, wash her hands with soap before feeding the child, and use clean utensils for feeding her. The CNE further counseled, “You can give her food and fruits in small pieces, pulse, rice, bread, you can also feed her supplementary nutrition packets provided by the Anganwadi center. The government is providing two packets per week to severely malnourished children.” After their discussion, the CNE asked Ankita’s mother to bring food for her daughter, then demonstrated how to feed the child properly. Ankita started to eat, and the CNE asked the mother to follow her instructions to make Ankita healthier. The mother agreed to do this.

The CNE and Anganwadi worker continued to make regular follow-up visits and give counseling to Ankita’s mother about nutritious foods. On October 30, 2017, the CNE screened Ankita again with the MUAC tape. Her MUAC was 13 cm. Now Ankita is healthy like other normal children. Ankita’s mother thanked the CNE and Anganwadi worker and asked to continue meeting regularly when the CNE comes to Bijasan. She also thanks Real Medicine Foundation.