India: Childhood Malnutrition Eradication Program
65 New Malnutrition Cases Identified: Q1 2017
May 23, 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
- 225 meetings with Anganwadi workers were organized by RMF India’s CNEs during routine field visits.
- 10 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 started 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.
- During the reporting period, RMF India’s CNEs educated 2,000 women and girls on personal hygiene and encouraging them to use sanitary pads during their menstrual cycles. Through creating this awareness, 1,100 women and girls have adopted the use of sanitary pads.
- 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.
65 New Cases
- 12 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).
- 53 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.
Social Enterprise Program
Education on Personal Hygiene
2,000 women and girls have been educated on personal hygiene and the use of sanitary pads since implementation of RMF India’s social venture began in late January 2017. 1,100 women and girls have adopted the use of sanitary pads thanks to RMF’s new social enterprise program.
Counseling and Education
- 1,918 family counseling sessions were conducted by RMF India’s Community Nutrition Educators (CNEs).
- 2,837 individuals (mainly women and adolescent girls) participated in the abovementioned family counseling sessions.
- 80 community education sessions were led by RMF India’s CNEs.
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.
Click to enlarge
During this reporting period, in addition to the 3,426 villagers who benefited from education and counseling sessions conducted by RMF India’s Community Nutrition Educators (CNEs), 128 children suffering from acute malnutrition were identified and/or received treatment:
- 65 children suffering from severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) were identified.
- 63 children suffering from SAM or MAM were treated, and their condition improved.
Treatment of Severe Anemia Saves a Mother and her Unborn Child
Real Medicine Foundation India provides humanitarian support to underprivileged communities through field coordinators known as Community Nutrition Educators (CNEs). Each RMF Community Nutrition Educator works in 10 villages with the help of government departments like Women and Child Development, the Health Department, and panchayats (village councils). CNEs educate families and communities about maternal and child health by using IEC materials (flipbooks) in one-on-one and single-family counseling secessions.
On December 16, 2016, CNE Akila visited the most remote village of Barwani district, Raigun, during her field visits. As her routine activity, she met with the Anganwadi worker and community members for a discussion of malnutrition in the community. After the discussion, CNE Akila followed up with a young woman named Kalibai, because she had come back to the community after a long time of traveling. She was pregnant and had now completed her 8 months of pregnancy; she would be delivering any time in the next month. The CNE asked Kalibai’s husband about her maternal and child protection card. This MCP card is given by an ANM to record progress from the registration of a pregnant woman to postnatal care and child immunization records, anemia, any other complications that the mother had, and the expected date of delivery.
After seeing this card, CNE Akila noticed that Kalibai had 4.4 mg/dL hemoglobin value in her body. The CNE checked Kalibai’s eyes and nails, and they were completely white. She also noticed edema. The CNE asked Kalibai about iron and folic acid (IFA) tablets, but she had not taken them because of vomiting. CNE Akila made Kalibai’s family and husband aware of her severe anemia. The CNE told them that if Kalibai’s anemia was not treated in time, then the mother and child might die or the child could have a low birth weight.
To avoid these severe problems, the government has established a blood bank in each district hospital. This supply is available free of cost from the government. After blood transfusions, the child and mother would be safe and healthy.
CNE Akila suggested admitting Kalibai to the district hospital immediately, but her husband refused to admit her to the hospital, because he was unfamiliar with the district hospital and admission procedures. The CNE called an ASHA (local accredited social health activist) and the Anganwadi worker to make them aware of the health status of Kalibai. They also requested that Kalibai be admitted to the hospital, but still the husband refused. CNE Akila educated the family about the district hospital facility and the admission procedure and provided counseling about care and nutritious food during pregnancy, but again Kalibai’s husband did not agree. Akila asked the ASHA and Anganwadi worker to keep a close eye on Kalibai’s health and to call the ambulance anytime, whenever she needed it.
CNE Akila reported to RMF India’s headquarters about Kalibai. Rakesh Dhole (Program Manager, RMF India) decided to visit the village of Raigun to meet with Kalibai’s husband.
The next day, Rakesh, along with Nilesh (RMF staff) and CNE Akila, visited Raigun to meet with Kalibai and her husband Kamlesh. Rakesh discussed the situation with CNE Akila and the Anganwadi worker and checked the MCP card. Our team asked Kalibai’s husband about his reason behind refusing admission. Kamlesh told us,
We both are illiterate and have never gone to district place and even not seen district hospital yet. We don’t know the procedure of admission and blood transfusions. I don’t know how to admit and how to get check-ups in hospital. That’s why I am refusing to admit her.
Rakesh told him not to worry, because an ASHA is in the village. The ASHA would call the ambulance and go along with the family. She would help in all basic formalities at the hospital. You just have to call the ASHA. RMF’s team also would like to help the family in the hospital. Now Kamlesh was happy and agreed to admit his wife to the district hospital and asked RMF’s team to meet with him at the hospital the next day.
The next day, Kamlesh went to the district hospital with Kalibai and the ASHA, then called RMF’s team. Rakesh and Nilesh reached the district hospital immediately, then helped the couple with admission and blood transfusions. The doctor admitted Kalibai for three to four days due to her severe anemic condition. RMF’s team continued to follow up in the hospital. On December 20, 2016, Kalibai was discharged from the hospital.
On January 4, 2017, CNE Akila visited the village of Raigun and followed up with Kalibai. CNE Akila checked her MCP card and found Kalibai’s hemoglobin values increased. Now Kalibai was normal and healthy.
Kalibai gave birth to a healthy little girl on January 22, 2017 in the government hospital. Now Kalibai and her husband Kamlesh are happy and well aware of the government hospital facilities. They have thanked CNE Akila and the rest of RMF’s team for their support. The baby is now 3 months old and healthy.
Successful Start of RMF’s Social Venture
Menstrual Hygiene Management
On January 26, 2017, on the occasion of India’s Republic Day, *Real Medicine Foundation started implementing a social venture program in 50 villages of Barwani block, Barwani distric*t, with the capacity of 10 community cadres comprised of RMF India’s CNEs, known as Swasthya Sahelis (Catalysts of Change).
Swasthya Sahelis make regular visits to villages, meet with women and girls (age 14 to 49 years), and speak with them about menstrual cycles and traditional practices that women are following during menstruation. Swasthya Sahelis also counsel them to adopt hygienic practices and use sanitary napkins, helping them to break myths and misconceptions about their menstrual cycles, like avoiding outings during menstruation and untouchability.
The Swasthya Sahelis help create awareness, teaching women and girls to use sanitary pads to protect themselves from yeast infections, RTIs (reproductive tract infections), fibroids, etc., and they also discuss the drawbacks of unhygienic cloths that women and girls are using during menstruation. Swasthya Sahelis explain that cloths are not very clean, and drying in a dark place, they are not free from germs and bacteria, whereas sanitary pads are manufactured and packed in hygienic conditions. They are packed in a wrapper, which you can tear whenever you want to use a pad. This is a safe method to use sanitary pads.
RMF’s Swasthya Sahelis are also leading sessions in schools and hostels to raise girls’ awareness of their personal hygiene and encourage them to use sanitary pads during their menstrual cycle.
RMF’s Swasthya Sahelis are working with approximately 20,000 eligible women and girls in 50 villages of Barwani block.
Our Swasthya Sahelis have reached 2,000 women and girls in the last three months, educating them about personal hygiene and encouraging them to use sanitary pads during their menstrual cycles. Through creating this awareness, 1,100 women and girls have adopted the use of sanitary pads happily and changed their menstrual hygiene behaviors for a better life. Now, they feel more confident. By also selling low-cost sanitary pads, RMF has increased project sustainability by generating INR 16,125 revenue and INR 3,800 commission for all Swasthya Sahelis.
The social enterprise has had a very successful start, but our teams have reported the following challenges:
- It was tough to change women and girls’ minds to use sanitary pads.
- Due to low family income, most women and girls are not able to purchase sanitary pads.
- Problem in disposing of pads in the village: Women and girls do not want to throw sanitary pads away openly or dump them, because of concerns that they might be used for black magic in the village.
- Without a recognized brand name, schools and hostels are not allowing us to sell these low-cost sanitary pads.
- Swasthya Sahelis are counseling women and girls without any IEC or BCC materials for pictorial presentations in field like flip charts, flip book, video projector or tablets