India: Childhood Malnutrition Eradication Program

Prateek and Savan

On Aprll 4th, 2014, RMF’s Khargone District Coordinator, Auntim Gupta, alerted the RMF team about a severe case of malnutrition in Galtar village of Jirnia block, Khargone. RMF’s CNE, Neelofar Mirza, had been working with a family of four for months, and both parents were unwilling to take the children to a hospital for care. Despite all of her efforts, the family was insistent that they could not take their child to the NRC, both due to constraints at home but also, more alarmingly, because they did not trust the care provided by the government system.

Both of the children, Prateek (5 years and 11 months old) and Savan (34 months) were suffering from SAM and an undiagnosed respiratory infection. Their parents, Bahadur and Munni, were aware of the gravity of the situation, and had consulted many of the local medical practitioners, including a traditional healer and an unliscensed medical provider. They had spent significant money trying to improve their children’s conditions. The medical practitioner had given the children vitamin supplements, and the traditional healer had performed a ceremony sacrificing livestock in an attempt to cure the children. Clearly, the family was willing to work towards the impovement of the children, but not willing to travel the two hours to Khargone to spend 14 days in the NRC. It’s a story RMF’s CNEs are very familiar with.

Auntim was not willing to let this matter rest, however. Together with senior staff, Auntim met with the Chief Medical and Health Officer (CMHO) of the district to mobilize government health staff. After sharing photos and the details of the children, the CMHO dispatched a local help supervisor and ambulance to Galtar to meet the family. The RMF team was not far behind.

Upon arriving in the village, the magnitude of the children’s malnutrition became apparent. With a MUAC of 7.0 and weighing just 5.48 kg, Savan was one of the most severe cases of SAM ever identified by RMF CNEs. His brother, also SAM with a MUAC of 10.7, was suffering from severe acute malnutrition for a second time. When speaking to the parents about Prateek, it became clear why they refused to go to the NRC: on every trip to the district hospital, the family had been mistreated, ignored, or even chastised for the state of the family, and they had no desire to return to a facility that not only failed to treat their son, but also cost them time, comfort, and took them away from their support structure.

After sitting with the family, Neelofar was able to make progress. Prateek had been one of her first referrals, and now, armed with 3 years of experience, she was able to confidently address all of the families concerns. Auntim, now familiar with the entire district health setup and all of the hospital staff, assured the family that their previous experience was an anomaly. After several hours of counseling, the family reluctantly agreed to go to the NRC.

Once in the Khargone district hospital, the staff of the new NRC immediately rose to the occasion. The new pediatrician immediately visited the family and calmly diagnosed both children, attributing their severe malnutrition to Tuberculosis, one of the more common malnutrition co-infections in Madhya Pradesh. He counseled the family, informing them of the duration of the treatment required, the protocol they needed to follow to treat their TB, the side-effects, and a detailed explanation of every treatment the NRC was providing. Although this seems basic, overburdened health staff often do not have the time to provide this standard of care. In addition, Auntim and Neelofar worked out a schedule to visit the family twice a day to provide them psychosocial support, address their concerns, shop for them in the local market, or communicate updates back to their family in their village.

Two weeks later, both children were stabilized and discharged from the NRC after achieving their target weight gain. Once back in their homes, both the children were regularly visited by the Anganwadi worker to monitor their weight gain and report and problems to both RMF and the local government health staff. The family is adhering to their TB treatment and, although they have a long way to go, both children are on the road to healthy lives.

Community Based Video Screening in Partnership with Digital Green

During the Second Quarter of 2014, RMF’s Malnutrition Eradication Program continued to be a strong presence in Madhya Pradesh (MP).

After successful trainings of the CNEs in Khandwa District in September, RMF began full operations with videos in October, producing four videos per month and screening in 50 villages. From April through June, RMF’s team completed more video production and also introduced new tools to verify adoptions and track the efficacy of the video in delivering health messages and knowledge in addtion to behavior.
In May 2014, a secondary training was held on dissemination and adoption verification to reinforce proper video screening and behavior change messaging as well as introduce new formats for knowledge recall adoption verification.

Since the introduction of these tools, RMF has seen the adoption rate quadruple in our target ares, with over 30% of viewers practicing promoted bahaviors either through direct practice or through increased awareness.

RMF’s new program focuses screenings on targeted populations of mothers and families with children under 5 years old in 3 district settings:

1. Cluster Screenings that target mothers in a small setting, usually 4-6 mothers, in their houses during the day.
2. Evening Screenings that target larger groups of 10-15 families and are screened when male family members can attend to increase their awareness of nutrition and health issues.
3. Mangal Diwas Screenings on Tuesdays at the Anganwadi Centre for ration distribution. By adding video screenings at the Anganwadi Centre on Mangal Diwas, RMF aims to both increase participation in ration distribution and also target at-risk families with health information.

From October 2013 to June 2014, RMF’s program with Digital Green in Khandwa has:

• Produced 36 Videos on Immunizations, Sanitation and Hygiene Practices, Management of Diarrhea, Locally available Nutrition Diet, and Immunizations, Government Services for Nutrition and Health under NRHM and ICDS, and Acute Malnutrition, how to identify it, and how to treat
• Conducted a total of 2,771 disseminations in 100 villages, reaching 10,839 households
• Recorded 2,963 practice adoptions directly resulting from our videos.