Programs to Address Malnutrition

Despite the progress that has been made on other fronts, including infant and child mortality, in India over the last decade, nutrition remains a major public health challenge and nutrition indicators for young children have barely changed. There are many factors that complicate ongoing efforts to implement successful community nutrition programs–including inadequate access to food, unhealthy environment and exposure to infectious diseases, and inappropriate care and feeding practices. Since its inception, MYCHI has targeted the nutritional status of young children in Fakir Bagan during the first 1,000 days of their lives, primarily through preventive care and counseling along with curative care as needed.

The earliest data on nutritional status of children based on weight for age was collected in October 2009. It showed that 33.3% of children 0-3 years old were normal weight, while 32.7% were mildly, 21.6% were moderately, and 12.3% were severely underweight. Two and a half years later, in May 2012, the percentage of severe underweight children has dropped by more than half—from 12.3% to 5.5%, a remarkable success. Data is currently being analyzed to explore the specific factors that have had contributed to the reduction of the severe underweight in our catchment area, but it is clear that the MYCHI approach to deliver key health interventions during pregnancy and young childhood coupled with close counseling, education, and preventive health have made a significant impact in our community.

Although we have made progress, there are still improvements to be made to our child health initiative in order to fully integrate nutrition and growth. This year, we began efforts to systematically address malnutrition and move away from short-term trials, which consumed disproportionate resources and time at the expense of our regular programs. We have made several recent changes to make it easier to monitor and track malnourished children, which we hope will help us reach every child at risk of improper nutrition and growth:

– Early this year, we began generating our lists for monthly home visits by health workers on the basis of the nutritional status of children. Children having a z-score of -3 and below in weight for age (severely underweight) are referred to Swastha Kendra for clinical examination. This also ensures that our health workers have nutrition and growth on their minds as they enter the home of each child and can provide appropriate and intensive counseling to the family.

– At Swastha Kendra the referred child is provided care to resolve any associated medical problems and given supplements for micronutrient deficiencies. Follow up homes visits are carried out by our health workers two days after the doctor’s visit to check up on the child.

– Last month, we designated a space in Swastha Kendra as a nutrition corner, where mothers can freely breastfeed younger children and feed older children when they come for a doctor’s visit. We offer a meal of kichuri and egg in this corner to malnourished children who have been referred by the health workers. The privacy of the corner also enables close counseling with the family.

– Child health community meetings have been re-started in our new community center for mothers of children 0-12 months with an increased focus on complimentary feeding, as we recognize that children begin growth faltering at the time of weaning and introduction of semi-solid foods.

We are optimistic that these changes will enhance MYCHI’s efforts to improve child nutrition in Fakir Bagan. – Danya Sarkar

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