India: Childhood Malnutrition Eradication Program
254 Children Identified and Treated for Malnutrition: Q4 2016
February 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
- 286 meetings with Anganwadi workers were organized by RMF India’s CNEs during routine field visits.
- 47 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 planning for 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.
Improved Nutritional Status
- 35 severe cases of malnutrition were treated and improved.
- 80 moderate cases of malnutrition were treated and improved to normal nutritional status.
Identifying New Cases
- 34 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).
- 8 severely malnourished children were admitted to NRCs after counseling.
- 105 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.
- 669 cases of moderate acute malnutrition (MAM) were followed by RMF India’s CNEs.
Education and Counseling Sessions
- 2,114 family counseling sessions were conducted by RMF India’s Community Nutrition Educators (CNEs).
- 3,147 individuals (mainly women and adolescent girls) participated in the abovementioned family counseling sessions.
- 132 community education sessions were led by RMF India’s CNEs.
- 919 individuals participated in the abovementioned community education sessions.
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.
- 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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During this reporting period, in addition to the 4,066 villagers who benefited from education and counseling sessions conducted by RMF India’s Community Nutrition Educators (CNEs), 254 children suffering from acute malnutrition were identified and/or received treatment.
Age: 1 Year
Rahul is 12-month-old boy who lives with his family in the village of Khedi, a small, tribal area with a population of 1,368, situated 15 km from Barwani district in Madhya Pradesh, India. Locals participate in agriculture or daily labor to earn their livelihood. Some also travel to other states in search of employment and return home after an interval of three to six months. Like many villagers, Rahul’s father works in agriculture, overseeing his agricultural produce.
On May 12, 2016, RMF Community Nutrition Educator (CNE) Sangeeta Badole visited the village of Khedi. She went to Rahul’s home and found that the young boy was extremely weak. She measured his MUAC (mid-upper arm circumference) at 11 cm. This indicated that Rahul needed to be treated for severe acute malnutrition (SAM).
To fully understand Rahul’s situation, CNE Sangeeta inquired about his history. Rahul’s parents informed her that the child was born at home. His birth weight had been 2 kg, and he was weak since birth because his mother had not been able to eat or rest properly during her pregnancy. After his birth, Rahul was neither breastfed on time, nor given regular and appropriate breastfeeding. This was because the elders of Rahul’s family believed that the initial milk of his mother was not good for him and breastfeeding should be started the day after birth and supplemented with cow’s milk and other food that could be provided. There were several other traditional myths and misconceptions that the family believed, which had also contributed to the young child becoming severely malnourished. Lack of proper education and awareness in the family had caused Rahul’s severe acute malnutrition (SAM).
RMF CNE Sangeeta began her counseling session with Rahul’s mother. She described the Nutrition Rehabilitation Center (NRC), where a child is admitted for 15 to 21 days with his or her mother and receives a proper diet and treatment under the supervision of trained staff like doctors and feeding demonstrators. CNE Sangeeta further explained that staff at the Nutrition Rehabilitation Center ensure timely follow-ups of a child’s health and feeding status, and if necessary, a doctor will refer the child to the hospital. Additionally, feeding demonstrators provide fresh food every 2 hours during the child’s stay; the child is fed 8 to 10 times a day. The Nutrition Rehabilitation Center even provides food for the mother and reimburses her Rs. 120 per day after four follow-up appointments have been completed for the child.
Our CNE’s counseling also emphasized that the utensils used for Rahul should be separate from other members of the family, which would help Rahul’s mother know the quantity of food the child had been consuming. CNE Sangeeta also emphasized that the mother must sanitize her hands properly before cooking and at the time of feeding her child.
CNE Sangeeta’s counseling changed how the family conducted itself with respect to the young child. On May 18, 2016, Rahul was admitted to the Nutrition Rehabilitation Center (NRC). His MUAC was 11 cm at the time of admission, but 14 days after, his MUAC had increased by .04 cm, to 11.04 cm. CNE Sangeeta counseled Rahul’s parents to complete 4 follow-ups at the NRC to further improve his health.
On August 26, 2016, Rahul’s MUAC measured 11.8 cm, and his health had begun improving. CNE Sangeeta continued to make regular visits to his home and counsel his family about complementary feeding and the preparation of nutritious foods. Rahul’s mother always followed CNE Sangeeta’s instructions and suggestions.
On December 12, 2016 CNE Sangeeta measured the young boy’s arm with the MUAC tape again, and she found an improved measurement: 12 cm, as compared to the previous measurement of 11.8 cm. Rahul’s parents and the entire family thanked our CNE for her commendable contribution towards educating and counseling them and improving the nutritional health of the baby. Rahul’s mother believes that if she had received such education on time, her child would never have had to experience such a painful trail. She vowed to share this message with every woman in her village and try to help the community understand this knowledge and become healthy.