Combating malnutrition

Written by Amar Patnaik

India faces a huge burden of malnutrition rooted in its social, economic, and cultural asymmetries and challenges. According to the National Family Health Survey (NFHS)-4 conducted in 2014-15, for children under five years of age, 38.4 per cent were stunted (height-for-age), 21 per cent were wasted (weight-for-height), 7.5 per cent were severely wasted (weight-for-height), 35.8 per cent were underweight (weight-for-age) and 58.6 per cent were anaemic.

These alarming statistics have further worsened, despite several targeted service delivery schemes and outreach programmes by the government. As per the NFHS-5 conducted in 2019, stunting has gone up in 13 states and wasting has gone up in 12 out of 22 states and UTs surveyed, respectively. This abysmal situation is further exacerbated by the emergence of COVID-19 which is expected to push many more children into malnutrition.

The worsening situation of malnutrition in India demands urgent attention and resources to prevent any further backsliding on nutrition indicators. With the revival of Mission Poshan and an allocation of Rs 20,105 crore earmarked for the new national nutrition programme, the government has shown intent to tackle malnutrition.

However, to fight the chronic burden of malnutrition and the simultaneous increase in severe acute malnutrition (SAM) in a holistic manner, more concerted efforts are needed. To achieve India’s “Sustainable Goal” target of reducing under-five mortality by 25 per cent by 2030, the country needs to revamp its strategy and adopt new methods of combating SAM.

Apart from the most popular method of treating children with acute malnutrition at the Bal Sewa Kendra (BSK) or Child Malnutrition Treatment Centers (MTCs), Community Management of Acute Malnutrition (CMAM) is a proven approach to manage SAM in children under five. CMAM involves timely detection and treatment of SAM children without medical complications with ready-to-use-nutrient-dense-foods at the community level itself.

At a time when the pandemic has disastrously upended access to basic healthcare for far-flung communities, leveraging this opportunity will go a long way in ensuring the last-mile delivery of health care services, should there be any other disruptions in the future.

In 2015, the Odisha government piloted CMAM in tribal-dominated Kandhamal district which had the highest levels of under 5-year child mortality in the state in 2012–13. A standard CMAM approach consisted of setting-up of treatment sites closer to the community, weekly monitoring of uncomplicated SAM children, an in-patient facility to admit children with SAM and associated medical complications along with provision of Modified Energy Dense Nutritional Food (EDNRF), Modified Hot Cook Meal (HCM) and Modified Take Home Ration (THR).

The targeted programme resulted in children achieving the desired weight after treatment, thereby significantly improving the nutritional status in the district. In fact, Odisha’s success in community-led and community-managed experiments in several fields including disaster management, forest management and waste management have become legendary now with only Kerala giving it some competition.

But while Kerala has been a forbearer of such praxis since long, Odisha has been able to reach this level in just the last 20 years with the advent of the Mission Shakti Programme — a scheme to organise women into self-help groups first as a livelihood initiative. In a similar vein, Rajasthan, Gujarat, and Uttar Pradesh are some of the other states that have also shown effectiveness towards this approach.

According to the CMAM Association of India, ready-to-use-nutrient-dense-food can ensure the recovery of a SAM child in two to three months at the community level in most of the cases and reduce the need for treatment at MTCs, ultimately reducing the chances of infections and the overall cost of treatment.

Currently, India does not have a framework or a set of guidelines to address the treatment and the prevention of SAM in children. But, as we gear towards the release of national guidelines for POSHAN 2.0, it is essential to streamline and integrate CMAM as a routine part of the government system.

Since, CMAM has the potential to tackle severe acute malnutrition by strengthening community health systems, a collaborative effort at the community level will ensure the efficient delivery of sustainable healthcare in times to come. Additionally, while prioritising SAM, learnings from best practices of other states, will hold the key to tackle the growing burden of malnutrition.

According to a study by Lancet 2019, multiple forms of malnutrition (MOM) reduce nearly 8 per cent of a nation’s economic growth. As the wealth of the nation depends not only on the skills and knowledge but health and nutrition of its people, it is high time that India caters to its eight million SAM children, if it aspires to be a $5-trillion economy by 2024-25.

The writer is member of parliament, BJD