India: Childhood Malnutrition Eradication Program

Laxraj

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.