India: Childhood Malnutrition Eradication Program

Case Study: Radhika’s Road to Recovery

February 18, 2016

Deepmala Cholkar, Prabhakar Sinha and Rakesh Dhole


Life Saving Education to Families

This story is of a village Nani Barwani, located 5 km away from Barwani district headquarters in the West Nimar region of Madhya Pradesh, India. The village, as this entire region, is predominantly tribal and inhabited by Bheel & Bhilala tribes.  Nani Barwani has a population of 4400 and most people there engage in work related to farming and labor associated with it.  As part of governmental service delivery provisions, there are 3 Anganwadi centers, a primary school and a health sub-center located in the village. The distance to the nearest Nutrition Rehabilitation Center is 5 km from the village, which is located at the district headquarters.

Close to the center of Nani Barwani village, there is a small hamlet called Chetaria, where the family of Radhika lives who belongs to the Bhilala community.  Radhika is 10 months old; her family is constituted by her 26 year old father Shiva, Manju, her 23 year old mother and her grandmother.  The family’s economic status is below poverty lines.  Radhika’s parents are daily wage earners whose meager earnings one way or another help manage the household expenses.

Home Visits and Education

This village is under the programmatic coverage of the Real Medicine & Nutrition Trust’s (RMNT) health & malnutrition prevention & management program (RMF’s Indian arm).  RMNT’s Community Nutrition Educator (CNE) appointed for the village conducts home visits as part of her programmatic mandate, screens children for their status on malnutrition and helps manage moderately and severely malnourished children with help from government front-line community workers, Anganwadi workers & others.  During one such recent routine field visit on January 4, 2016, RMNT’s CNE happened to screen Radhika and it was distressing that her MUAC measurement was found to be at 10.5 indicating that she was a severely malnourished child.  Worried, the CNE wanted to probe as to what had led to Radhika’s case to be so severe.

The CNE was told that Radhika was born at home and weighed 2 kg at birth.  Soon after birth, Radhika was not breastfed and was given cow’s milk.  Her mother started breastfeeding her only after a day of birth which had continued up to a period of 9 months after the birth. Beyond the 9th month, Radhika was given complementary food, such as biscuits, toast, and finger chips, etc. The reason: Radhika’s mother wasn’t aware about the right time & method of starting complementary feeding for the child.  The CNE was also told that Radhika suffered from recurring episodes of diarrhea. The result was: by the time screened, Radhika had reached a state of severe malnutrition and looked thin, pale and weak.

Treating the Person as a Whole

The CNE shared the case of Radhika with the concerned Anganwadi worker and both reached out to the family and counseled, including recommendation for an immediate referral of the little girl to the Nutrition Rehabilitation Center for proper care and support which the child required. The family was also made aware about services the NRC would offer which would also partially offset the wage loss that the family would suffer during its stay at the NRC.  Both CNE & the Anganwadi worker’s repeated rounds of joint counseling and persuasion helped to handle the family’s fear and inhibition in taking Radhika to the NRC.  The family also received assurance from these two ‘social change agents’ that their food and stay at the NRC would be taken care of.  Finally, Radhika’s father agreed to take the girl to the NRC.

On January 11, 2016 Radhika was admitted to Barwani district NRC. On completion of 14 days at the NRC, Radhika’s MUAC measurements showed signs of improvement and were found to be at 10.8 which were indicative that she was on the road to recovery in 14 days of care at the NRC. Although Radhika had not fully recovered yet and had a long way to go, signs of Radhika getting better day after day were clearly visible and that was being recognized by the family and care givers at the NRC.  Radhika’s parents were full of gratitude for both RMF’s CNE & the Anganwadi worker for being helpful in saving Radhika’s life.



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.