Alleviating malnutrition in UP, “one Chintu at a time!”

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Heera Lal, District Magistrate, Banda – Uttar Pradesh talks about Bal Poshan Satra, which harnesses community resources to help malnourished children with special focus on SAM cases

“It doesn’t mean much, but it means a lot”, malnutrition remains to be a leading risk factor for health loss for all ages across India (Lancet 2019). While the overall burden of malnutrition has gone down, severe acute malnutrition (SAM) continues to rise. A national population-based study shows that the SAM burden for Uttar Pradesh (UP) has increased from 5.1 per cent (2005-06) to 6 per cent (2015-16).

As one of the most populous states in the country, even a slight change in the health status of UP has the potential to affect the overall health status of our nation. In response to this growing burden of malnutrition, the UP State Nutrition Mission (SNM) was launched in 2014 to strengthen coordination and synergies between departments to address malnutrition. Further to the efforts of the SNM, the launch of POSHAN Abhiyaan in 2018 by the Prime Minister, Narendra Modi, which has doubled the pace of fight against malnutrition.

While hospital-based care for SAM is important, several experts around the world have emphasised the importance of a community-based response to children with uncomplicated SAM, which constitutes almost 90 per cent of SAM cases. The Bal Poshan Satra (BPS) from UP is an innovation which leverages community resources to bring malnourished children out of the vicious cycle with special focus on SAM cases.

The BPS sessions are conducted at Anganwadi Centres (AWC) where the mothers of SAM children are not only acquainted with appropriate feeding and care practices but are also encouraged to participate in the preparation of nutritious recipes for their children. These learnings help them in understanding the importance of right feeding practices and are replicated at home. These sessions provide an excellent opportunity for community workers to initiate communication for behaviour change (BCC) on key nutrition-specific and sensitive interventions like the importance of breastfeeding and timely introduction of complementary feeding, dietary diversity, meal frequency, hand washing, disposal of faecal matter, immunisation etc. using positive examples from within the community.

A good example of how a community-based approach to address SAM has proven to be a success is the story of Chintu (name changed to protect the family’s privacy), hailing from a small village called Bhagelawari of Banda district in Uttar Pradesh. Chintu is one of the many children with SAM who has benefited from an innovative community-based model for providing comprehensive care to SAM children.

At seven-months, Chintu weighed only 5.5 kg and was identified with SAM during a screening drive by three community workers (Anganwadi Workers/AWW, Accredited Social Health Activist/ASHA, and Auxiliary Nurse Midwife/ANM).

Poor hygiene, recurrent illness and lack of access to complementary foods after six months of age were the main reasons for his condition. As a medically complicated case of SAM, Chintu was referred to the nearest NRC, however, due to various personal reasons the family was unable to make the trip to NRC.

Due to the severity of his condition, Chintu was taken to the community health centre (CHC) instead. From here, he was administered necessary medicines, counselled and then enrolled to attend the 12-days BPS at the local Anganwadi Centre (AWC). Chintu’s mother partook in all 12-days of the BPS, followed by fortnightly follow-up sessions at AWC for the next two months and for monthly health check up in Village Health Nutrition Days- the outreach sessions conducted by ANM. She religiously followed the feeding recommendations, prepared energy-dense food preparation at home, which she learnt during the feeding demonstrations at the BPS and fed it to Chintu promptly. Subsequently, by the end of the three-month phase, Chintu was able to achieve full recovery.

Interestingly, the BPS programme has greatly benefited from the district-based strategy that not only leveraged funds for organising BPS but also brought the Departments of Health, Integrated Child Development Services (ICDS), Rural Development and Panchayati Raj under one umbrella to prioritise children like Chintu, screen them for malnutrition and SAM, while maintaining a robust monitoring system for implementation and document the learnings.

The work that started from one block has now been scaled up in the entire district. In the words of Heera Lal, District Magistrate, Banda, Uttar Pradesh. “Our journey for tackling malnutrition has just commenced, we have a long way to go. The results have been possible due to support from all my departments.”

Chintu’s story is an inspirational one and much can be learned by other states on how using local community-based strategies of care and treatment can help in tackling child malnutrition. The story of Chintu gives us hope that severe acute malnutrition (SAM) can be addressed. Moreover, the POSHAN Abhiyaan and National Health Mission (NHM) flagships provide the opportunity for reaching the last child with both home and facility-based care along with necessary medical management. Thereby continually improving India’s chances of reaching the global SDG 2030 vision.

Anganwadi CentresBal Poshan SatraChintuIntegrated Child Development ServicesmalnutritionNational Health MissionPOSHAN Abhiyaansevere acute malnutrition
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