Tackling Acute Malnutrition in Children: Awareness, timely follow up visits key factors for community programs: Dr Sujeet Ranjan

Less than 10 lakh children in India have Severe Acute Malnutrition! The figure was shared by the Women and Child Development Ministry in Rajya Sabha on Thursday, as reported by PTI.

Several notable measures have been rolled out to improve nutritional quality, testing and delivery through leveraging technology. However, there are several challenges as well.

The Coalition for Food and Nutrition Security (CFNS) recently launched a Dossier on Models of Community Care of Children with Acute Malnutrition.

Addressing how the existing challenges can be overcome with a clear and outcome driven strategy, Dr Sujeet Ranjan, Executive Director of The Coalition for Food and Nutrition Security (CFNS), shared detailed insights on the same with Financial Express Online.

Dr. Ranjan is associated with the Public Health Nutrition sector for over two decades. Prior to Coalition, he has worked as Director – CARE International in India and COO – Swasthya Management and Research Institute, Hyderabad.

Edited excerpts of the interaction:

How will the dossier contribute to the learnings for designing a program on community management of acute malnutrition (CMAM)?

The dossier presents the strategy, implementation process, progress and status of the pilots/ interventions of community-based programs for managing children with acute malnutrition undertaken by various organisations in different parts of India. It also highlights the variations and similarities between these pilots/ interventions. The achievements and challenges of these projects can guide in deciding the way forward and design of the community-based program.

What have been the key challenges faced by the interventions quoted in the dossier?

The key challenge reported by most of the organizations was the short duration of the project. The interventions not being a regular program, the identification could not be continued, the new children identified could not be enrolled in the program and the relapsed children could not be admitted. The other limitation due to the short span of the project was limited community sensitization and mobilization.

Also, the projects had more focus on providing direct services and were passive in building the role of caregivers as well as community in taking up health issues for collective action. Almost all projects witnessed high defaulter rates due to migration, absenteeism due to festival seasons and difficult accessibility to the treatment.

What are the key recommendations regarding community-based programs for managing children with acute malnutrition?

Holistic Approach: Prevention and treatment should go hand in hand, interventions to focus on other forms of undernutrition simultaneously.

Integration: Integrating CMAM into health & ICDS systems, making it a regular program. Defining roles and responsibilities and accountabilities.

Convergence: The other departments like Agriculture Department, NRLM, Tribal development department, department of rural development and social welfare should create a committee and function as technical and/or programmatic advisors, with joint accountabilities clearly defined.

Treatment Protocols: Protocols of managing SAM under 6 months needs to be rolled out soon. Identification using both MUAC and Weight for Height, MUAC as a tool for first level screening at community level. Involving Rashtriya Bal Suraksha Karyakram (RBSK) doctors’ team for assessing medical complication at community level could ensure the correct line of treatment for SAM children.

Capacity Building: Integrating training on CMAM into the pre-service training plan of FHWs. The capacities of FHWs need to be strengthened on identification focusing on both MUAC measurement, weight and height measurement and also on IMNCI package for identification of medical problems.

Real time monitoring & reporting: Integrating validation checks and mechanisms for prompt and useful feedback for the FHWs, an ICT based platform would help all the levels of the programme in reducing the time required to rectify an error and for follow-up action.

Strong and continuous community mobilizing: The messages and activities directed to mobilize the community should be contextualized in local language, based on the socio culture practices and using existing local channels and platforms.

Experience sharing: Proper documentation including process, outcomes, successes and challenges backed by authentic quantitative and qualitative data and supported by case studies and photographs is very critical.

What were the key areas of collaboration between the CSOs and State lead community based programs?

Most of the CSO lead programs were dependent on the government frontline workers for identification and for medical examination, assessing medical complication and referrals. On the other hand, in many state led programs the CSOs supported the community mobilization and follow up of children.

What were the key enablers contributing to the success of the projects?

Most of the projects were supported by the respective State Governments’ Department of Health and Family Welfare along with the Integrated Child Development Scheme (ICDS). Other government partners included Tribal Development department, Central Government Special Assistance Scheme, etc.

Apart from the main organisations, the projects were supported by several national and international organisations. The programmes included several measures for the prevention of SAM such as individual counselling, dissemination of information on health, nutrition, handwashing, ORS preparation, breastfeeding, etc., and several group discussions with the parents and caregivers.

Along with these measures, kitchen gardens were introduced to the community members for access to nutritious food right in their backyards and demonstrations of cooking nutritious meals. Awareness was sought to be the most important factor to help prevent SAM in children. There were timely follow-up visits to prevent relapse of SAM and tried to conduct 100% screening regularly. Training and skill development were one of the major components to ensure quality. Data was maintained in spreadsheets and it was validated at frequent intervals for proper monitoring. Most of the programmes involved trained professionals as supervisors for medical, BCC and data collection and monitoring, and evaluation was done on a regular basis. The hierarchical structure ensured accountability and thus ensured the quality maintenance of programmes.

[Disclaimer: The interview is for informational purposes only. Please consult experts and medical professionals before starting any therapy or medication.]