India: Childhood Malnutrition Eradication Program
Third Quarter 2014 Malnutrition Eradication Program Report
January 22, 2015
Michael Matheke-Fischer, Prabhakar Sinha, Santosh Pal
CNEs Successfully Trained
Full Operation with Videos Begins
After successful trainings of the CNEs in Khandwa District in September 2013, RMF began full operations with videos in October, producing four videos per month and screening in 50 villages.
Village Training Sessions Continue
Thousands Get Information
During this quarter the program conducted 630 training sessions, with over 4,217 people in attendance, and 17,762 family counseling sessions.
A Challenge for Families
One of the largest challenges facing our CNEs, and the treatment of SAM in MP in general, is getting children requiring treatment to the NRC.
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.
• Identified 525 children suffering from SAM and gave counseling to the caregivers of each of these children
• Saw an improvement from SAM to MAM in 392 children
• Identified 1,527 new children with MAM and provided one-on-one counseling to the caregivers of these children
• Saw an improvement from MAM to normal in 2,025 children
• Successfully ensured the 14-day treatment of 206 of the most serious cases at local Nutrition Rehabilitation Centers
• Conducted 630 village nutrition training sessions, with over 4,217 people in attendance
• Conducted 17,762 family counseling sessions
Laxraj is a 21-month-old boy from village Jamli, District Khargone. The village is 8km away from the District headquarter and has a good approach road with easy public transport facility. The village is scattered in 3 different ‘faliyas’ (Hamlets). Most families are educated and well off, whereas, a few families are engaged in manual labor. Laxraj lives in a small ‘pacca’ (concrete construction) house with his mother, Malti (22 years) and father, Santosh (26 years). Laxraj is first and the only child of the parents. Presently, Laxraj is living in a nuclear family – with only his parents. However, when Laxraj was identified as SAM, he became part of a joint family and moved in with his grandparents. The joint family was engaged in farming for the source of livelihood.
In January 2014, Laxraj was identified as Severe Acute Malnourished with 11.4 cm MUAC by Community Nutrition Educator Ranjeeta Rathore. He didn’t attend the Aanganwadi Centre regularly, thus, he did not get supplementary nutrition from the Aanganwadi Centre. After being identified as SAM, CNE Ranjeeta approached the Aanganwadi worker to discuss the malnutrition Status of Laxraj. After discussion, they collectively decided to meet with his family, and went to them and revealed the status of Laxraj to the parents. They also informed them about the causes and consequences of malnutrition. The CNE referred the case to a Nutritional Rehabilitation Centre at Khargone district headquarters. Laxraj was admitted there and stayed there for 14 complete treatment days.
After returning home from the NRC, Ranjeeta and the Aanganwadi worker visited Laxraj and observed changes in the child. Not only were his MUAC measurements showing signs of improvement, but his weight had also gone up to 6.890 kg from 6.465 kg. Though Laxraj’s health status had improved, he wasn’t completely out of danger. Once again, his conditions started deteriorating when Laxraj’s family moved away from his grandparents’ home. After this separation, Laxraj’s mother started working in fields as a laborer and she used to carry Laxraj along when she was out to work. On February 10, CNE Ranjeeta went for a follow up and found Laxraj’s MUAC at 11.6 cm. She asked his mother about her feeding practices, and found that, although she was breastfeeding, he was not receiving any other complementary feeding, such as semi-solid foods of rice or lentils, which is appropriate for his age and necessary for his growth. Ranjeeta counseled his mother on complementary feeding and continuous breast feeding.
In the month of March Ranjeeta again met him in Suposhan Abhiyan, the village health and nutrition day, and took a MUAC measurement which was 11.7 cm. She counseled his mother again. Subsequently, Ranjeeta conducted follow up in April and May 2014, she found his MUAC was improving, moving to 11.9 cm in April and 12.1 cm in May. In the month of June when Ranjeeta went for a follow up, she found that Laxraj was suffering from diarrhea. Ranjeeta, with support from a local ASHA, provided ORS and Zinc tablets to his mother and counseled her on prevention and management of diarrhea. This time Laxraj’s MUAC was 12 cm. In the next follow up visit on July 14, Ranjeeta found that the child wasn’t going to the Aanganwadi Centre regularly. She requested his mother to send him to the Aanganwadi Centre. His mother showed her inability to send him to the Aanganwadi Centre as she had to attend to her daily field work during the day time.
CNE Ranjeeta and an Aanganwadi worker then met with Laxraj’s grandmother and asked her to support her grandson to continue his recovery from malnutrition. After a long discussion she was willing to look after him during the day time. After resolving some interpersonal issues between the mother and grandmother, Ranjita started conducting regular follow ups of the child. Through a close monitoring that the CNE conducted in August and September, she found that Laxraj’s MUAC measurement had gone up to 12.6 cm.
At this stage, the CNE counseled Laxraj’s mother about family planning. She also reiterated the importance of supplementary nutrition, hygiene and sanitation, public health facilities, balanced diet, etc. Finally, Laxraj’s family started adopting healthy behaviors and always followed health workers’ guidelines. In the last visit Ranjeeta undertook in October 2014, Laxraj’s MUAC measurement was 12.7 cm, fully recovered from malnutrition.