malnutrition crisis in india

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India: Barwani Pilot Program for our Eradicating Malnutrition Initiative

January 24, 2011 in Asia, Caitlin McQuilling, General, Helping Children, India, Providing Medical Support, Rebuilding Communities by Jonathan White | Comments closed

Introducing a new pilot initiative within RMF’s Eradicate Malnutrition Program:  Strengthening Community Management of Childhood Malnutrition through community mobilization, and nutrition and health education of mothers and pregnant women in Barwani, Madhya Pradesh

Madhya Pradesh has the highest rate of childhood malnutrition in India, with upwards of 60% of all children under 5 years old underweight.  In many tribal communities in the state, this rate may be even higher, with alarmingly high rates of severe and moderate acute malnutrition.  These communities often have limited access to government resources meant to prevent and treat malnutrition and have low levels of awareness about proper young child care.

To respond to these alarming levels of malnutrition in Madhya Pradesh, the Real Medicine Foundation (RMF) launched a childhood malnutrition program across 5 of the worst hit districts in Southwest Madhya Pradesh – Jhabua, Alirajpur, Khandwa, Khargone, and Barwani – employing 55 local women to act as Community Nutrition Educators to help empower communities to combat malnutrition and to identify children with severe acute malnutrition.  Given the success of these women in addressing malnutrition at the community level over the last year, RMF is teaming up with the Department of Women and Child Development and the Madhya Pradesh Technical Assistance Support Team MPTAST) to roll out a pilot program in Barwani district to address childhood malnutrition through community mobilization.  This program is supported with financial help from DFID and from technical assistance from Action Against Hunger.

Our staff attending training session

Project Objective

To build the capacity of anganwadi workers and supervisors to drive community mobilization and provide high quality health and nutrition education services in order to develop community capacity to recognize malnutrition, respond to malnutrition using local resources and make referrals when necessary, and to prevent malnutrition in the long-run.

Target Area

This pilot program will provide full coverage to two blocks in Barwani District – Pati and Barwani blocks –with a total of 204 villages and 370 anganwadi centers.  The target population will be children under 5 years old and pregnant and lactating mothers.

Barwani is a remote and rocky district at the southern most corner of Madhya Pradesh, boarding Maharashtra and Gujarat, with a population of 10,81,039 (2001 census).  It is the second most tribal district in Madhya Pradesh, with 67% ST population.  The size of each village varies from roughly 800 and 3000 people, with larger towns scattered throughout the blocks.  Barwani is considered one of the most remote districts of India.  Many of its villages are located in hilly regions, cut off from roads and access to markets.

Staff in the field

Social Mobilization Approach

The project’s social mobilization approach is founded on strengthening the capacity of the government’s ICDS programme to mobilize communities for child nutrition by delivering quality nutrition and health education classes to mothers.  This will lead to increased community understanding of child nutrition issues, more women and families adopting better nutrition practices, and increased demand for government services that people are entitled to.

The project will achieve this by capacitating Anganwadi Workers, Supervisors and CDPOs to hold regular monthly community sensitization meetings to generate interest in and sustain momentum for community action.  The sensitization meetings will increase awareness of malnutrition, its signs and the care that malnourished children need. Tools are being developed to help raise awareness of the scale of malnutrition in the village, how it can be identified, the location of pockets of malnutrition in the village, and stimulate debate on what individual families and the community can do to address this problem.

Through awareness raising events, influential persons and opinion leaders will provide support to the sensitization program through the Village Health, Sanitation, and Nutrition Committee which will serve as the local nutrition monitoring group. These newly formed Village Health, Sanitation, and Nutrition Committees will monitor the regularity, reach and quality of services provided at the Anganwadi Centre.  They will provide feedback and suggestions to key members of the local community and will report any gaps in services to the panchayats for community action. Community leaders and influential persons and the local monitoring group will meet regularly to share monitoring information, help resolve local problems and enable the smooth functioning of Anganwadi Centres. Additionally, by focusing on strengthening anganwadi supervisors’ capacity for supportive supervision, the project will not only institute a system of stronger monitoring and evaluation into the program, but will begin a process of on-going trainings.

Output

As a result of the on-going capacity building and trainings, this project will capacitate Anganwadi Workers to hold regular, participatory and practical health and nutrition education sessions for the mothers of malnourished and underweight children.  It will also strengthen their interpersonal communication skills which will benefit other elements of their duties.

Anganwadi Workers with support from Supervisors and CNEs will hold nutrition and health education classes twice a month.  CNEs will also assist supervisors and anganwadi workers on active case finding in children from hamlets and areas within villages who are not currently accessing anganwadi resources and will help connect these families with the system.  Referrals for complicated cases of SAM and MAM will be made to the Barwani NRC.

Progress thus far

RMF began the groundwork for this project in November 2010 and officially started working on the project at the project’s approval in December 2010.  The first step was to introduce the program to local leadership, and then work to recruit new positions for the program, begin developing manuals and IEC/BCC tools, hold the training for new CNEsm and to make the plan for the project moving forwards.

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For more information about RMF’s Malnutrition Eradication Program in India, click here.

We can use any financial help you are able to provide on this project to continue our Education, Treatment and Outreach and help towards our goal of Malnutrition Eradication in this region of India.

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India: The Importance of a Whole Health Approach

September 1, 2010 in Helping Children, India, Jaimie Shaff, Voices from the Field, Whole Health by Jonathan White | Comments closed

Maria and Pankaj

The Importance of a Whole Health Approach: malnutrition and psychosocial neglect

By Jaimie Shaff

With malaria season at its peak and migrant families returning home, complicated cases of severe acute malnutrition (SAM) are presenting themselves at the NRC daily. In my short time here, I have seen a steady caseload of children presenting signs of tuberculosis, worms, malaria, diarrhea, and vomiting. For every child that comes into our NRC, we attempt to provide the best possible treatment, addressing underlying health conditions and symptomatic responses. Most complicated cases will flourish with antibiotics, de-worming tablets, and nutritional support while more serious cases might require a blood transfusion and vigilant monitoring.  Fortunately, medication and care is enough for most children.  Their ailments will be properly treated, their bodies will receive much needed nutritional support, and their caretakers will leave with new knowledge for malnutrition prevention.

However, there is another side to malnutrition in Madhya Pradesh that can’t be treated with pills or an IV—psychosocial neglect. In MP, there are many factors that lead to a decline in focus on the emotional development of children, such as parental employment, migration, and death. While the resiliency of children is naturally high, the ability to cope largely depends on temperament of the child and dynamics of the neglect.

Last week, a seven-year old girl, Maria, came to the NRC with a 3-year-old boy, Pankaj. Pankaj was found to be suffering from SAM complicated with a respiratory infection. Once he was admitted, it was noticed that he wasn’t interested in eating, was unresponsive to sensory stimulation, and appeared listless and sad. After some discussions with Maria and some other caretakers at the NRC, we figured out that Pankaj’s mother had passed away and his father migrated for work. Maria was Pankaj’s aunt and caretaker. Imagine being seven years old and handed a very sick three-year-old boy to care for.  Despite her age, Maria looked after Pankaj to the best of her ability, taking her motherly role in earnest.

Every time I went to the NRC, I worried about Pankaj. I had never seen a child in such a depressed state. Even Urmila, our 9-month-old suffering from malaria-induced anemia, was responsive to stimulation.  Pankaj would not play, walk, talk, or crawl. He ate with a cloak of reluctance and, when left alone, would suddenly start screaming until Maria returned. When I caught the rare glance from Pankaj, I found myself overwhelmed with sadness. His eyes told the story his voice could not.

One day, Pankaj was sitting on the floor by himself with a pile of rocks, barely moving.  I had noticed that Pankaj had a slightly enlarged head and appeared to only use one side of his body in his rare attempts to scoot across the floor. I sat down to play with him, and felt incredibly accomplished when I finally got a smile and a laugh. I watched as he demonstrated equal muscular strength, reflexes, and spatial understanding. He even surprised me with his ability to process thought when it came to counting, adding, and removing objects from his visual field. For all intensive purposes, Pankaj was significantly less developmentally challenged than we had thought. Maria returned and tried to get him to walk again. Typically, Pankaj would scream and go limp in his legs. This time he walked!

The next day I walked into the NRC and Pankaj smiled with recognition. He then grabbed my hand and began to walk. You cannot imagine the emotions that flooded into my being as I saw the effect a small amount of inter-personal play can have. With just a half-hour of attention the previous day, Pankaj began to smile, interact, and react with myself and others. Pankaj was not just starved for nutrients—he was starved for attention.

When Fabian, our Country Director came down to check on patients, he noticed Pankaj’s stature—the enlarged head, downward glance, etc. The initial diagnosis is that Pankaj suffers from hydrocephalus, a disorder that causes cerebrospinal fluid to build up in the brain. This ailment typically requires a shunt to be placed to drain the fluid from the brain. Unfortunately, these procedures are rare in the developing world as they are costly and riddled with complications. Children who receive the procedure require rigorous monitoring, as the shunt can shift, become infected, or be rejected by the body.  For a child of 3-years old whose caretaker is a 7-year old girl, the operation is not an easy option.

Emotional support is essential to the betterment of a human life. Treating the medical issues without addressing the whole-developmental being is not enough. I am proud that RMF works to empower its staff to address the social and emotional needs of its patients.  With this step, we are working to improve every aspect of a person’s health to provide the best possible course of treatment. We may not be able to fix his hydrocephalus, but we can take a step to improve his quality of life right now, medically and mentally.

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