‘Active community-based management of acute malnutrition is crucial’

Even as India celebrates its Poshan month, the battle against malnutrition promises to be a long one. While malnutrition has decreased to an extent, the burden of severe acute malnutrition (SAM) is on the rise. According to National Family Health Survey (NFHS-4, 2015-16), in India, 7.5 per cent of children aged under five are suffering from SAM as compared to 6.4 per cent being severely wasted (SAM) as per NFHS-3 (2005-06). Globally, nearly 20 million children aged under five are suffering from SAM and to date, it remains a major cause of death among children. Dr Mrudula Phadke, senior adviser, National Rural Health Mission, Unicef, and former vice-chancellor of Maharashtra University of Health Sciences, tells Anuradha Mascarenhas that in Maharashtra, active case finding through community-based management of acute malnutrition has shown the way forward. Excerpts from an interview:

What is the current burden of malnutrition in Maharashtra? Has it changed over the past five years?

Maharashtra has seen a decline in stunting (too short for their age) by 15 per cent during 2006-12. However, wasting (too thin for their height) and severe wasting (SAM) in Maharashtra have continued to increase over the years, growing from 16.5 per cent and 5.2 per cent in 2005-06 to 25.6 per cent and 9.4 per cent in 2015-16, respectively. While there are several reasons that lead to SAM among children, most studies have highlighted that it is a sociocultural problem. The most common cause of SAM among children is protein or energy insufficiency in their diet.

What is being done to address the issue?

In 2018, the government set up the Poshan Abhiyaan with the vision to eradicate malnutrition by 2022. Soon after that, Maharashtra became the first state to set up a full-time nutrition mission known as the Rajmata Jijau Mother-Child Health and Nutrition Mission, and it was primarily aligned with the need of young people, the poor and the most vulnerable populations. In response to the growing number of SAM children, Maharashtra also went on to implement a community-based management of severe acute malnutrition (CMAM) strategy, where community workers helped identify and manage cases through use of different centrally and locally produced therapeutic food.

What are the bottlenecks faced by Poshan Abhiyaan in Maharashtra that can be averted by other states?

Community-based management programme is crucial to address SAM in the state. However, the programme faced some bottlenecks. Government reports indicate that there are two primary challenges: one in relation to supply and logistics of therapeutic food (produced in India) sachets to remote parts and the other that over 41 per cent anganwadi centres (AWC) are inaccessible.

What are the key takeaways?

Despite roadblocks, the Maharashtra story is definitely a landmark for India on how CMAM can help address thousands of children who are suffering from SAM, and who, without active community-level efforts continue to go undetected and are usually missed by the health system. Under the CMAM strategy, anganwadi workers (AWW) were particularly instrumental in active case finding, or proactively screening children to detect SAM cases, and were especially helpful in identifying cases in two ways: by making door-to-door visits or by screening them during village health and nutrition days (VHND). As part of Bal Sanjeevani, mothers were also provided counselling, either at their house or in communities, on what to feed their children.