India: Childhood Malnutrition Eradication Program
Eradicating Malnutrition and Improving Healthcare Practices: Q2 2016
October 18, 2016
Rakesh Dhole and Deanna Boulard
Summary of Activities
The project’s goal is 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. 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.
Since our Malnutrition Eradication Initiative began in 2010, this program directly impacted:
- The tribal rural population of 881,741 people in Madhya Pradesh, through RMF’s program coverage in 15 administrative blocks of 5 tribal districts Barwani covering 71,628 households in 600 villages.
- The program has directly impacted 36,290 children in the age group of 0-6 years.
- More than 3,227 children have received lifesaving treatment.
- 555,933 individuals from rural villages have received training on malnutrition awareness and prevention in their villages.
- The families of the CNEs RMF employees as part of this initiative, many of whom are from the intervention villages themselves and use their salary from RMF to support their children’s education and to improve the lives of their families.
Making a Difference
Preventing, Identifying, and Treating Malnutrition
- 1,186 households received CNE counseling services.
- 1,537 individuals (mainly women and adolescent girls) participated in the abovementioned CNE household counseling sessions.
- 7 severe cases of malnutrition were treated and improved.
- 34 moderate cases of malnutrition were treated and improved.
- 15 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.
- 42 new moderate 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.
- 8 cases of severely malnourished children were referred to Nutrition Rehabilitation Centers.
Recording Health Practices
Determining Needs for Social Enterprise
Survey data analyzed thus far:
- Total villages surveyed: 50
- Total rural tribal population in the 50 villages: 76,635
- Total households in the 50 villages: 15,000
Survey key findings:
- 85.6% of rural respondents are not using sanitary napkins.
- 53.6% of the rural population is unaware of the purpose and use of sanitary napkins.
- 87.6% of the population is not using mosquito nets.
- 40% of the local population is not using nail clippers (out of 1,500 respondents).
- 84.5% of the rural population is not using panties.
- 99.3% of the rural population is not regularly using soap for handwashing before eating and after defecation.
Social Enterprise Model
Preparations and Plans
- An MOU has been signed with the government of Madhya Pradesh for support of ABM activities in 5 districts of Madhya Pradesh.
- This pilot project’s goal will be to cover 98 villages through the involvement of 10 Swasthya Sahelis.
- Each CNE is to act as a depot-holder for affordable products and choices that help communities improve healthcare practices by adopting hygienic behaviors.
- Each community cadre will have a cluster catchment of 10 villages and will cater to a population range of 10,000 to 15,000.
- Each cadre is to act as a “Swasthya Saheli” (Catalyst of Change) and lead a long-term campaign: “Swasthya Samudai, Swasthya Pradesh” (Healthy Community, Healthy State).
- Every Swasthya Saheli is to distribute these products: sanitary napkins, panties, soap, mosquito nets, nail clippers, first aid kits, pregnancy test strips, water purifiers, and condoms.
- Capacity building of the team to handle the social enterprise is being prepared.
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.
Case Study 1
Timely Counseling Leads to Child’s Recovery
Bajjta is a small, tribal area with a population of 1,535, situated in the Barwani district of Madhya Pradesh. Locals participate in agriculture or daily labor to earn their livelihood. Some residents also travel from their village in search of employment and return home after an interval of three to six months.
This story is from Bhilat Baidi, a hamlet in the village of Bajjta Khurd. This is where an 8-month-old baby girl named Anmol lives with her family, including her grandfather, grandmother, mother (23-year-old Sulochna), and her father (25-year-old Mukesh). Anmol’s father works in agriculture, overseeing his agricultural produce.
On April 15, 2016, an RMF Community Nutrition Educator (CNE) visited the village hamlet of Bhilat Baidi. Our CNE stopped at Anmol’s house and found her to be extremely weak. She took the child’s MUAC measurement and found it to be at 11.7 cm. This indicated that Anmol needed to be treated for Moderate Acute Malnutrition (MAM). Therefore, the CNE started inquiring about the child’s history.
Anmol’s parents informed the CNE that the child was delivered at home. After her birth, Anmol was neither breastfed on time, nor given regular and appropriate breastfeeding. This was because the elders of Anmol’s family believed that the initial milk of her mother was not good for her and breastfeeding should be started a day after the birth and supplemented with cow’s milk and other food that could be provided. As far as routine immunization was concerned, Anmol received a BCG vaccination, but because she cried for the whole day, her parents did not pursue further vaccinations.
There were several other traditional myths and misconceptions that the family believed, which had made the small child suffer. Lack of proper education and awareness in the family had caused the baby’s Moderate Acute Malnutrition. Our CNE began her counseling session with Anmol’s parents, which included:
- Referring the family to seek Anganwadi services and get registered there
- Initiation of complementary feeding with periodic intervals
- Continuation of breastfeeding up to the age of 24 months
- Explaining the importance and process of administering all doses of vaccination to the child
The CNE’s counseling also emphasized that the utensils used for the child should be separate from other members of the family, which would help Anmol’s mother to know quantity of food the child had been consuming. She also emphasized that the mother must sanitize her hands properly before cooking and at the time of feeding her child.
Our CNE’s counseling changed how the family conducted itself with respect to the child. This change was able to eliminate crucial problems of malnutrition that Anmol was suffering from.
On May 12, 2016, when our CNE again approached the Anmol’s parents and measured the young girl’s arm with the MUAC tape, she found an improved MUAC measurement: 12.9 cm, as compared to the previous measurement of 11.7 cm. Anmol’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. Anmol’s mother was of the opinion that if she had received such knowledge and education before and on time, her child would never have had to face such a painful trail. She further promised, with great determination, that she will convey this message to every woman in her village and try to make them understand this knowledge and help the community become healthy.
Case Study 2
Empowering Women to Pursue Safe Water
The story is from a village called Badgaon, which is situated in the Barwani district of Madhya Pradesh. It is a highly tribal village with a population of 4,114 inhabitants. The literacy rate is minimal, and residents’ livelihoods solely depend on agricultural work, which is seasonal.
In Badgaon, our local Community Nutrition Educator (CNE), Salita Dawar, works with great enthusiasm under the banner of Real Medicine and Nutrition Trust (RMNT) to find and treat malnourished children under 5 years of age. She screens children for malnutrition by measuring their Mid-Upper Arm Circumference (MUAC). Our bright and determined CNE also educates lactating mothers and pregnant women about nutritional requirements during pregnancy and breastfeeding, works with Anganwadi workers and ANM, and participates in all types of community meetings to raise health awareness.
During a routine survey in Badgaon, CNE Salita found several female residents discussing something among themselves: They were highly ashamed that they didn’t have a facility for safe or potable drinking water in their village. They had to walk up to 2 or 3 kilometers to fetch water. Our CNE encouraged the women to be confident, and added that they would have to take initiative and move forward to fix this problem.
Even after CNE Salita encouraged the women to take action, they were reluctant to pursue the subject further. She counseled them again and asked the women to take their problem to the Panchayat Sarpanch (the town council secretary). In case their problem wasn’t heard there, they could then raise the issue in Gram Sabha. Even if they failed to present their problem in Gram Sabha or it was not resolved there, they could approach the District Collector.
The local women formed their own team and approached the head of the village Panchayat, but he did not pay any attention to their problem. After several days, a program called “Gram diwas se Bharat diwas” was launched by the government, where citizens could present their social problems to officials. But unfortunately, the secretary of the Gram Panchayat would not allow the women to approach senior officials.
Once again, our CNE Salita Dawar stepped in and discussed the matter with the women. She found that they were disappointed, but had not lost hope. The women asked CNE Salita for advice, and she provided guidance by saying that they should draft a letter and present it to the grievance cell of the district.
They shared their problem with the District Collector, who issued an order to make a water supply connection in Badgaon. Our CNE Salita Dawar motivated the team of village women, and with perseverance, they were able to resolve their problem. The whole village is thankful for the role that CNE Salita Dawar played in the process.