India

• Forty percent of all underweight children in the world are Indian
• Over 60 million Indian children under 5 are underweight
• With 42% of India's children underweight, the country's future will be prone to illness and with physical and mental effects that will last a lifetime

Staggering figures, but we have to start somewhere.

RMF will start by working with government, NGO, UN, corporate, and civil society partners in Madhya Pradesh to treat severe and moderate acute malnutrition at community levels and to simultaneously train local communities in malnutrition identification, treatment, and long term prevention. This micro malnutrition intervention will empower local communities by focusing on local solutions and education in some of India's most poverty stricken, rural, and marginalized communities.

We will focus on the state of Madhya Pradesh¹, a state of 60 million, where the worst malnutrition indicators in India have been reported. An estimated 60% of children in this state are malnourished, leading to the Global Hunger Index to place MP in between Chad and Ethiopia in its list of the world's worst malnutrition ratings. An estimated 1.25 million children in the state have severe acute malnutrition (SAM) and another 1 million are living with moderate acute malnutrition (MAM). This alarming rate is tied to the high level of poverty in the state; the 2007-2008 District Household and Facility Survey found that 76.5% of the households in Madhya Pradesh have a low standard of living.

The pilot phase of this project in MP is expected to reach 100,000 malnourished children ages 0-15 years old by treating the malnourishment, bringing the children back to normal growth patterns, and ensuring that there are no relapses by educating the children's families on preventing malnourishment. By building the capacity at local health centres and dispensaries to identify acute malnutrition and treat uncomplicated cases, we will be able to reach a larger portion of our target population, the most rural and vulnerable populations of the country.

Our project is based on the fact that treating malnutrition earlier is not only more effective and less risky to patients; early treatment is also more cost effective when combined with a community based approach. This catalytic activity will strengthen existing systems, structures, and management capacity of partners at the most local and grassroot levels to address the issues of the most marginalized and vulnerable populations in India.

Project Objectives

The first step to eradicating malnutrition is an emergency step: to treat all 1 million + children in Madhya Pradesh who are suffering from malnutrition presently to prevent further deaths and to simultaneously work to prevent malnutrition through community tailored trainings and other prevention activities.

Our goal is to identify and treat severe acute malnutrition within the community before the onset of complications and growth stunting.

We will do this by:

• Involving multiple partners and coordinating activities with other organizations working to curb malnutrition
• Integrating our project with existing preventative initiatives and tailor interventions to each individual community
• Increasing coverage of intervention and community mobilization and case finding through extensive local networks.
• Using our technical expertise in the areas of medicine, supply chain management, and politics of the region.
• Negotiating with suppliers to get the best rates for the program
• Conducting trainings at multiple health care and community levels in best malnutrition prevention and treatment practices

Project components:

• Early detection combined with local, decentralized treatment and follow up
• Training of communities and community health works to identify severe acute malnutrition (SAM), stages I-IV
• Train health care workers to identify complicated cases of malnutrition from uncomplicated cases of malnutrition.
• Set up referral mechanism for all children with cases of complicated malnutrition (less than 20%) to facilities of treatment
• Arrange weekly follow up visits for all home-based malnutrition patients (either by a visit to local health centre or by a visit to the home by a trained health worker)
• Arrange for weekly follow up visits for all patients discharged or who voluntarily withdrew from facilities
• Continuing training for all families in the community on malnutrition prevention
• Use of latest technologies to ensure careful monitoring, evaluation, and recording of project to prove efficacy, identify problems and to facilitate replication

For further reporting on the severity of malnutrition in India, refer to the following articles:

http://www.nytimes.com/2009/03/13/world/asia/13malnutrition.html?em

http://www.smh.com.au/world/the-hidden-hunger-behind-indias-huge-success…

http://news.bbc.co.uk/2/hi/south_asia/7669152.stm

¹ RMF has several long-term public health projects in Jhabua district