Since uncomplicated cases do not need admission in rehabilitation centres, parents do not miss out on wages
A new study shows that treating children suffering from malnutrition at home produces better results than admitting them in Nutritional Rehabilitation Centres (NRCs). Home-based treatment reduces drop-out rates and helps to improve health indicators for children.
The study, published in latest issue of The American Journal of Clinical Nutrition, was conducted by Darbhanga Medical College Hospital, Bihar and non-profit Medecins Sans Frontieres (MSF). It is based on results from the community-based management of acute malnutrition (CMAM) programme that has been operational in Bihar’s Darbhanga district since 2009.
The study revealed that the community programme has achieved a cure rate of 88.4 per cent among severely acute malnourished children who completed their treatment. “We prefer to treat children at home unless they have a medical complication. We also use community resources like Accredited social health activists (ASHA) workers. This approach has been fruitful,” said Pujya Pascal, advocacy coordinator at MSF.
The study, titled ‘Community-Based Management of Severe Acute Malnutrition in India: New evidence from Bihar’ details the results obtained between February 2009 and September 2011. During this period, 8,274 children aged 6-59 months old, suffering from severe acute malnutrition (SAM), were admitted into the CMAM programme.
About 91 per cent of SAM cases were uncomplicated and were treated as outpatients in the community using an Indian manufactured, WHO-standard, ready-to-use and therapeutic lipid-based paste. Cases with medical complications were treated as inpatients in NRCs using therapeutic milk until they were fit to resume treatment in the community.
In an alternative approach, all children, with or without medical complications, are admitted to NRCs. This dissuades parents as they lose their wages till the child’s condition improves.
“ASHAs have access to the community. They go door to door and identify malnourished children by measuring Mid-Upper Arm Circumference (MUAC). They write referral slip which is used by parents for treatment of the child,” said Pascal. Parents have to take children once a week to NRCs.
Drop-out, or defaulter rate, was found to be 37.2 per cent, which is much higher than the international standard of less than 15 per cent. However, it was significantly low for Indian standards. For example, the NRCs in Uttar Pradesh have a defaulter rate as high as 47.2 per cent.
“Of the total children, 87.3 per cent belonged to Scheduled Caste, Scheduled Tribe, or Other Backward Caste families or households; 79.9 per cent were between six months to two years, and 62.2 per cent were girls,” said one of the authors, Prince Mathew, suggesting that severe acute malnutrition is disproportionately a condition of the most vulnerable populations.
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