India: Childhood Malnutrition Eradication Program

Case Study: A Successful Recovery

July 20, 2016

Iccha Bai



Bridging the Gap of Misconception


Bharati is a 24-month-old girl who lives in the village of Balkuan. The village has a population of 4,200, and most inhabitants belong to Bhil, Bhilala, or Barela tribes. Balkuan is located in the Barwani District of Madhya Pradesh. The main source of employment in this village is agriculture, which is seasonal and depends largely on rain water. Apart from farming, community members’ source of livelihood comes from casual work and daily wages. 

As part of governmental service delivery provisions, Balkuan has four Anganwadi centers, one high school, and a primary health venter.  The nearest Nutrition Rehabilitation Center is 15 km from Balkuan. The village is made up of seven clusters, one of which is Ghatiya Baidi. Bharati lives in the Ghatiya Baidi cluster with her 28-year-old father and 25-year-old mother. Bharati is only 24 months old and has two elder sisters. The family is struggling greatly to meet household expenses. 


Community Nutrition Educators

Balkuan is part of Real Medicine & Nutrition Trust’s (RMNT) health and malnutrition program. RMNT’s representative Akeela Sheikh has been deployed there as a Community Nutrition Educator.  During one of her routine visits, Akeela visited Bharati’s home and took the child’s MUAC measurement. She found that Bharati’s MUAC was 11.5 cm and the child weighed only 6 kg, which revealed that she was severely malnourished. After discussion with Bharati’s parents, Akeela discovered that up to the first six months after birth, Bharti was in good health. As the child grew older, the family faced acute poverty and both her parents had to go out looking for work, leaving Bharati in the care of her elder sisters. Since the family was unaware of the proper time and methods of introducing complimentary foods, the only complementary foods they gave Bharati were biscuits and tea, causing her diarrhea. As a result, she started losing most vital elements of her body.  Because Bharati suffered from acute diarrhea, she needed to be treated at a private nursing establishment.  

After reviewing the whole case study of Bharati, the CNE Akeela Sheikh, referred the child to ICDS “Suposhan Abhiyan.” As per the campaign, Bharati was enrolled and given nutritious food 3 to 4 times a day for 12 days. The family was counseled on feeding Bharati with nutritious, homemade foods at the right intervals. As the days of care and support progressed, Bharati stared to recover. Her body started showing signs of improved health and nourishment. With CNE Akeela’s tireless efforts on the ground, she achieved wonderful results. With all the hard work that the CNE and Bharati’s caregivers had put into her care, Bharati’s MUAC measurement had improved to 12 cm.

Malnutrition is caused by ignorance, myths, misconceptions, economic deprivation, and uncaring attitudes toward individual children in multi-sibling settings. The CNE’s role is to bridge such gaps on the ground. 



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.