Ms. Meeta Mathur, Dr. R.C.Panda, and Mr. N.M Prusty
Since 2018, every year India celebrates the month of September as POSHAN Maah. It helps raise conversation, consciousness and visibility on food and nutrition. It’s heartening to see that the stakeholder Ministries have expressed their commitment to the objective of Poshan Maah and planned activities to bring Nutrition in focus through their structural and programmatic verticals.
This year the Ministry of Women and Child Development had planned a series of activities with four weekly themes during Poshan Maah as a part of “Azadi ka Amrit Mahotsav”; which included “identification of SAM (Severely Acute Malnourished) children and distribution of nutritious food” as one of the themes. The 4th Rashtriya Poshan Maah aimed to ensure a speedy and intensive outreach to mobilise communities and encourage people’s participation for addressing malnutrition amongst young children, and women and to ensure good health and nutrition for everyone. It is important as the social and economic crisis has been triggered by COVID-19 pandemic, thereby posing grave risks to the nutritional status of young children. Of particular concern is an expected increase in child malnutrition, including wasting, due to steep declines in household incomes, changes in the availability and affordability of nutritious foods, and interruptions to health, nutrition, and social protection services. A modelling study of the indirect effects of the COVID-19 pandemic indicated an increase in wasting prevalence to account for 18–23% of additional child deaths. India alone could see an additional sixty thousand child deaths (it can be around three lakhs under the worst possible scenario) in six months. An estimate of 9,27,606 severely acute malnourished children from six months to six years were identified across the country till November 2020, based on the RTI query responded by the Ministry of Women and Child Development. Village Health Sanitation and Nutrition Day,
Responding to the situation, an unprecedented momentum and interest among many states and districts during Poshan Maah has been towards identification of children with SAM and exploring opportunities for strengthening elements of SAM care within the existing Government program. The prioritization to a drive for early identification and referral of severe acute malnutrition in children is a well appreciative effort that could provide specific direction for early identification and management of these children while minimizing the risk of developing medical complications. However, since March 2020, due to COVID-19 pandemic, regular ICDS and health-services have been severely constrained. Optimal care for children, especially those who are malnourished has been disrupted.
Though the early identification of children suffering from SAM during Poshan maah is significant, ensuring continuity of services and management in the community for children identified as SAM or MAM is non-negotiable. Further to the celebration of Poshan Maah and identification of these SAM children, it is important to provide a package of services and nutrient dense food to support the recovery and growth of the SAM child. The package of essential services for SAM includes– (i) assessment of medical complication (ii) medicines and supplementation – antibiotics, deworming, IFA, Vitamins (iii) interpersonal counselling on feeding, hygiene, sanitation and access to essential health and nutrition services (iv) follow up – regular growth monitoring and tracking of progress (v) referral for medical complications (vi) nutritional support through nutrient food.
These services can be easily delivered to SAM children closer to home through existing systems of health and ICDS. With this modality of service provisioning, majority of children who are wasted can both be identified and treated by frontline workers and SAM children who have medical complications and need specialized clinical care can be timely referred to inpatient treatment. The Village Health Sanitation and Nutrition Day (VHSND) can be utilized for medical assessment of SAM child and providing required medicines and supplementation by the ANM. Further, children with SAM and MAM need to be provided with appropriate nutrient foods that meet the requirements of the children with wasting through the ICDS systems. These could include the enriched/fortified/augmented take home ration suitable for the children with wasting. Mothers and caretakers need to be provided appropriate counseling and messages regarding appropriate care for SAM and MAM children. The child’s progress should be monitored on a weekly/fortnightly basis for a duration of 4 months till the time the child has recovered to normal status. Once recovered the child should be continued to be monitored during monthly growth monitoring and promotion sessions. A health card for every SAM / MAM child should be prepared providing health and nutritional status of such a child. ANM should compile details of each SAM/MAM child in her jurisdiction. Going by this modality the case-finding and treatment can begin before the prevalence of malnutrition escalates and additional medical complications occur and services can reach out to the maximum number of SAM/MAM children in need of the treatment.
A positive and favourable environment further needs to be built for these children at the Anganwadi Centres as well as community level. The Village Health Sanitation and Nutrition Day (VHSND), should be continued following Covid-19 appropriate behaviours, adapting to appropriate alternatives at the community level for ensuring continuation of essential services – immunization, health check-ups, screening, growth monitoring, IFA supplementations, nutrition counselling etc with involvement of PRIs/Women Self Help Groups / mothers’ group and family.
The impetus gained during Poshan Maah need not only to be kept up but stepped up. The focus should not be limited to the identification of SAM but expand to management of SAM children, preventing relapse with the ultimate goal of reducing the number of wasted children. There is a strong need for a mainstream community-based approach for the prevention and management of wasting.
(Meeta Mathur is Senior Technical Advisor, Dr. R.C.Panda, Former Secretary to GoI, Member of Executive Committee- National Nutrition Mission, CFNS Chair and N.M Prusty is Member Governing Board, The Coalition for Food and Nutrition Security. Views expressed are personal and do not reflect the official policy or position of FInancial Express Online.]