Potentials, Experiences and Outcomes of a Comprehensive Community Based Programme to Address Malnutrition in Tribal India

Abstract

This paper demonstrates the effect of an innovative community-based management programme on acute malnutrition among children under three years of age, through an observational longitudinal cohort study in tribal blocks in central-eastern India. The key components of the programme include child care through crèches, community mobilisation and systems strengthening to ensure better child feeding and caring practices and delivery of public health and nutrition services. For a cohort of 587 children, the increase in children in the non-wasting category is from 72% to 80% (p<0.001) and the reduction in Severe Acute Malnutrition (SAM) from 8% to 4% (p<0.005), a reduction of 46.6%. Normalcy is fairly well maintained at 89%. Among the severely wasted, 16% show no improvement, 49% moved into a moderate wasting category and 36% to normalcy over 4-6 months. Among the moderately wasted, 26% showed no improvement and 7% declined to a severely wasted category, and 67% moved to normalcy. The average Weight for Height Z-score (WHZ) for the cohort improved from-1.41 in the initial period to-1.13 in November (p<0.0001). This study suggests that this medium term strategy using a rights-based participatory approach for community based management of malnutrition may be comparatively effective by current WHO guidelines and other known community based interventions in terms of mortality, cost, degree and pace of improvements.

Effectiveness of NGO‐government partnership to prevent and treat child wasting in urban India

“…Other facility and community‐based nutrition programmes in India have had similarly low performance in recovery rates (Aguayo et al, ; V. M. Aguayo et al, ; Burza et al, ; Prasad & Sinha, ; Singh et al, ). In the only Indian multicentre randomized trial evaluating the efficacy of ready‐to‐use therapeutic food (RUTF) for community‐based treatment of uncomplicated severe acute malnutrition, recovery rates were below 41% at 8 weeks of treatment; after extending to 16 weeks, over 40% of children had not yet recovered (Bhandari et al, ).…”

Outcomes of Children with Severe Acute Malnutrition in a Tribal Daycare Setting

“…In April 2013, it was decided that for the purpose of uniformity across crèches, heights would be measured at entry point and in the months of May and November each year for all children, irrespective of their date of admission. The outcomes of 45 SAM children were reported early in the program as part of a cohort of 587 children in all categories [1]. These 45 children are also included in the current analysis.…”

“…ommunity-based management of malnutrition remains a challenge for India with limited numbers of Nutritional Rehabilitation Centers (NRC) providing facility-based care for a small proportion of children with Severe Acute Malnutrition (SAM) [1,2]. Action Against Malnutrition (AAM) is a model that offers comprehensive care to children below the age of 3 years through day-care facilities, and works closely with women on nutrition-action through Participatory learning and action (PLA) cycles, home visits, and close liaison with related government facilities and services.…”

“…While some program outcomes based on similar data have been published previously [1], limitations included small sample size and possible reference of seasonality. This study seeks to circumvent these limitations by nutritional outcomes of a larger set of children across seasons, considering the same intervention over a similar period of time (4 to 6 months).…”

Management of SAM and MAM

“…For example, some studies have suggested that, nutrition counselling, particularly focusing on improving infant and young child feeding practices, may be as effective as specialized foodbased interventions for the treatment of MAM (Roy et al, 2005;Prasad and Sinha, 2015).…”