Nutrition

Tackling malnutrition among excluded children

ECHO-supported CBDRR initiative by UNICEF in Bihar

By Aditya Malaviya

PATNA, INDIA: Kaushlya Devi and Ranjit Manjhi are proud parents of two young children: one-and-half-year old Rakesh Kumar and seven-month old Chandan. They live in their mud-and-brick hut in the non-descript village of Madhubani Ghat in East Champaran district of North Bihar.

Kaushalya and Ranjit belong to a socially excluded schedule caste. Their family also includes their seven other children. The family is landless and agricultural labour is their sole source of a livelihood.

With the village located very near to rivers Buri Gandak and Dhanauti - originating in the Himalayas - the village is always highly vulnerable to flooding.

Indu Jha, one of the forty village motivators trained under the Early Recovery Programme for Flood Mitigation supported by UNICEF and the European Commission Humanitarian Office (ECHO) visited the Kaushalya and Ranjit family to screen children for malnutrition.

Severe Acute Malnutrition

On investigation, she measured both Rakesh and Chandan with a Mid Upper Arm Circumference (MUAC) tape and found that they were both suffering from severe acute malnutrition (SAM).

Indu was aware of the serious consequences of SAM for child survival, as children with SAM are 5-20 times at a greater risk of death if treatment is delayed. 

At the time of admission in the programme, Rakesh weighed 5.5 kilos, while Chandan tipped the scale at 3 kilos. The MUAC reading was 111 mm for Rakesh and 82 mm in the case of Chandan, well below the SAM cut-off limit of 115 mm established by WHO and UNICEF.

East Champaran has the advantage of a functional Nutrition Rehabilitation Center (NRC) for the treatment of children with SAM, like Rakesh and Chandan. Kaushalya, along with two sons, agreed for the in-patient treatment. As a result of treatment at the NRC for 14 days followed by regular counseling by Indu, the level of malnutrition in both children substantially went down.

Two months after admission in the programme, Rakesh had gained 700 grams in weight, while Chandan had gained 400 grams; similarly, the MUAC reading increased by 11 mm for Rakesh and 10 mm for Chandan.

Constant follow-up to promote improved feeding and care practices and to empower mothers to prevent and recognize malnutrition in their children, proved to be rewarding. Demonstrations on how to improve the quality of complementary foods and feeding practices, preparation and use of oral rehydration salts (ORS), and improved hand-washing and hygiene practices were key sessions that Indu facilitated during mothers’ meetings and home visits.
 
“The priority being given by Government of Bihar and UNICEF to strengthen community-based interventions and the provision of services to prevent and treat malnutrition among children of socially excluded populations is beginning to make an impact” says Dr Farhat Saiyed, Child Nutrition and Development Specialist with UNICEF Bihar.