Dr Saurabh Tiwari, Associate Sector Lead, HCL Foundation highlights the importance of home based nutrition in tackling malnutrition in India
COVID-19 caused one of the major disruptions to the health, and holistic development of children. Close to 1.5 million schools in India remained closed due to the lockdowns in 2020. The result: about 100 million children were robbed of mid-day meals, their primary source of nutrition.
The nutritional status of the infants and young children worsened too. As it is, only about 6.4% of children aged 6 to 23 months receive a minimum acceptable diet in India as per UNICEF report. The job losses and dwindling household income further constrained the ability of millions of families to feed the young ones properly.
But the pandemic has also afforded opportunities for innovation in nutritional interventions – especially community based management of malnutrition strategies, adopted for the identification of malnourished children, organizing dietary support, and promoting better health & hygiene behaviours. In the wake of the lockdown restrictions, the fulcrum of nutrition campaigns quietly shifted from communities to home – for the better.
If the experiences of the nutrition campaigns conducted by various organizations during the pandemic years are any indication to go by, the home-based approach scores well over the community-based ones on a number of parameters including the reach, scope, and effectiveness of the camps. Though children have to be brought to a common location for anthropometric screening (study of measurement and proportions of the body) and medical screening for identifying malnutrition and malnutrition-associated illnesses, respectively, the core interventions and follow-ups are done at home settings.
Diets, door delivered
Poor food and meal infrequency can largely explain why over 40% of children under five in India are underweight (low weight for age), 38% of them are stunted (low height for age), and over 20% are wasted (low weight for height). Hence, a major component of any nutrition camp is taking nutritious food to the affected children. In the past, people had to come to a common location to collect the food. However, in home-based nutrition campaigns, meals are taken to the doorsteps of the malnourished children.
An important aspect of a nutrition campaign is counselling. Unless the parents and families are better sensitized and better informed, they would fail to take care of the nutritional needs of their children after the follow-up period. In home-based strategies, counselling sessions are conducted at home. As they happen in their own home, parents and family members are more forthcoming to share and collect information. The counselling is tailor made and the training, if any, is more customized.
Organisations providing home-based nutrition support
Organisations like HCL Foundation have been working towards elimination of malnutrition through a multi-sectoral approach. Under its flagship programme, HCL Samuday, the Foundation aims at creating a practical solution to improve the existing nutrition status of the population, particularly of children between the ages of 6 months to 5 years, through home-based nutrition campaigns. In March 2020, HCL Samuday identified about 2,000 children as Severe Underweight (SUW) or those having Severe Acute Malnutrition (SAM) in Hardoi district of Uttar Pradesh. These children were then enrolled in a 14-day home-based nutrition campaign. After a 5-month follow-up, over 1400 children (about 70%) moved to Moderate Underweight/Moderate Acute Malnutrition or normal category. Typically, the average positive category movement in a community-based nutrition camp came to about 60%.
Children were provided with three meals (one energy-rich premix and two energy/protective foods) every day in prescribed age-specific quantities; parents were counseled – and mothers were trained to make premixes at home with easily available and local ingredients. The inter-sectoral measures made this campaign holistic. As part of the campaign, members of the households were also trained to raise nutrition gardens at home that can go a long way in helping parents fulfill the daily nutritional requirements of children. As malnutrition has socioeconomic causes, the campaign provided support to increase the household income through income augmentation linkages to Self Help Groups and micro-enterprises.
Considering, the better outcomes of home-based nutrition campaign, organisations working in the area of malnutrition can identify and institutionalise the best practices of home-based approach and adopt them for their future interventions in the post-COVID-19 era.