India: Childhood Malnutrition Eradication Program

Vanshika’s family sees a new dawn

Silawad, a small hamlet with a population of 8,000 is located at a distance of about 21 kilometers from Barwani district headquarters. For the health service provisions, there are 6 Anganwadi centers and one community health center with an almost adequate number of staff in place.

Pawan, an unemployed 27-year-old man, lives in one of the Harijan (lower caste) faliyas with his mother, father and wife Renuka of 23 years of age. The couple has a 7-month-old beautiful, but malnourished girl child, named Vanshika. Pawan’s father is a government schoolteacher. As Pawan is unemployed, his father has to take care of all household expenses.

On June 25th, 2013, Nasreen Patel, one of the RMF CNEs of Silawad and Durga Badole, and an Anganwadi worker together were visiting their area as part of their routine field visit. During the course of this visit, the Anganwadi worker spoke with Nasreen about the severity of Vanshika’s malnutrition and requested Nasreen to visit her house. Together, they visited Vanshika’s house and counseled Vanshika’s mother, Renuka, who was counseled on the continuity of breastfeeding and the timely introduction of supplementary feeding. They were surprised to find that Renuka was pregnant for 4 months and could not breastfeed Vanshika properly, one of the factors leading to the severity of malnutrition of Vanshika. Seeing the repeat of pregnancy and the physical conditions of the mother and daughter, the duo counseled Vanshika’s mother on supplementary feeding for improving the condition of Vanshika. At the same time, Vanshika’s pregnant mother was guided on taking care of nutritional precautions, especially keeping her own pregnancy in mind. Vanshika’s mother was also educated to consume iron folic acid tablets and take 3 Tetanus Toxoid injections while she was pregnant. Both the CNE and AWW shared with her information about services of the Anganwadi center and encouraged her to avail the services of the AWC.

The MUAC measurement conducted on Vanshika revealed that she suffered from SAM. Nasreen’s counseling to Vanshika’s mother also included the side effects of malnutrition on the future wellbeing of her child. Further, both the community based cadre of service providers talked about the services at the Nutritional Rehabilitation Centre, where medical treatment is provided for SAM, but in the wake of the 4-month pregnancy of Vanshika’s mother, the family refused to take Vanshika to the NRC.

After having understood the internal complexities of Vanshika’s family leading to the failure of the NRC referral, Nasreen, RMF’s CNE spoke with Vanshika’s mother at length on ways and means by which she could improve the nutritional status of both herself and her child. The aspects that Nasreen counseled Vanshika’s mother on included: preparation of nutrition rich food at home, keeping the precautions of health & hygiene, maintain the immunization calendar of the child, seeking the services of AWC and ANM’s sub-center, regular visits to Anganwadi centers for collection of supplementary food, etc.

The first follow-up visit conducted by the same CNE after a month revealed that both mother and child were improving on almost all aspects of their health and wellbeing. The child showed a visible improvement of MUAC reading of 11.5 from the last month’s base line of 11.0. Vanshika’s mother showed significant signs of improvement as far as her own anemia was concerned. The CNE maintained the consistency of her follow up and regularly visited the family to track the condition of mother & child. In the subsequent visits that the CNE conducted for tracking the case of Vanshika, her nutritional status had improved substantially. From 11.0 cms, Vanshika had reached the MUAC reading of 12.9 cms. In the meantime, in November 2013, Vanshika’s mother gave birth to a healthy baby boy in the hospital. Through the programmatic consistency that RMF’s CNE demonstrated and maintained for a period of one year, the health of a village woman and her severely malnourished child could be transformed, and Vanshika’s whole family saw a new dawn.