The Malnutrition Program

Introduction :

The nutritional status of under-five children in urban slums is an important health indicator for assessing the health status of the entire population. Malnutrition is one of the most important public health problems globally. Malnutrition may affect the physical and mental development of children along with high morbidity. Children with severe acute malnutrition have a 5-20 times higher risk of mortality due to infectious diseases like diarrhea or pneumonia
According to World Health Organisation, around 1.1 billion people globally do not have access to improved water supply sources whereas 2.4 billion people do not have access to any type of improved sanitation facility. About 2 million people die every year due to diarrhoeal diseases, most of them are children less than 5 years of age. The most affected are the population in developing countries, living in extreme conditions of poverty, normally peri-urban dwellers or rural inhabitants.
Among the main problems which are responsible for this situation are: lack of priority given to the sector, lack of financial resources, lack of sustainability of water supply and sanitation services, poor hygiene behaviour, and inadequate sanitation in public places including hospitals, health centers, and schools. Providing access to sufficient quantities of safe water, provision facilities for sanitary disposal of excreta, and introducing sound hygiene behaviour are of capital importance to reduce the burden of disease caused by these risk factors.

Need for Malnutrition Program:

Investing in nutrition is a key way to advance global welfare; the global nutrition community is uniting around the Scaling up Nutrition movement. The United Nations Secretary-General has included the elimination of stunting as a goal in his Zero Hunger Challenge to the world. Many actions and strategies are planned by Government however non-government sector and corporates also need to contribute a lot to achieve the goals. To respond to the national need of taking action for `Combating Malnutrition’, Snehdeep Jankalyan Foundation, a Pune-based NGO has undertaken a comprehensive program since 2015 with the help of Tata Motors Limited. As it is indicated above there are a considerable proportion of malnourished children in the slums of Pune city. Therefore, SJF proposes an intervention in Pune slums during 2018-19.

Objectives of The Programme:

Experience of Snehdeep for all those years revealed a fact that malnutrition is not merely a lack of food intake but it is a multifactorial phenomenon, in which medical, social, economic, and environmental factors play a role. Each one’s family environment and culture along with its dietary habits are also equally responsible for children’s nutritional status. Therefore, understanding those background conditions and factors affecting a child’s nutritional status and addressing those by a systematic strategy is very significant while combating malnutrition. Sustainability will take place only then when those underlying causes will be addressed. Therefore, Snehdeep Jankalyan Foundation proposed the program with the following objectives:

To improve the nutritional and health status of malnourished children under 5 in slum areas of Pune City.
To facilitate changes in the dietary habits of enrolled children under 5
To build awareness among target families as well as the community at large on :
- Preventive health (Immunization, developmental milestones, illnesses, etc), Nutrition, Sanitation and Hygiene, Parenting.
To strengthen target families by identifying problem issues and providing information, guidance, and counselling to make them self-sufficient and confident.

Strategies Applied:

CMAM Program: CMAM is Community Based Management of Acute

Malnourishment. CMAM is a methodology for treating acute malnutrition in young children using a case-finding and triage approach. Using the CMAM method, malnourished children receive treatment suited to their nutritional and medical needs. CMAM is one of World Vision’s core project models in nutrition.

The Community-Based Management of Acute Malnutrition (CMAM) approach enables community volunteers to identify and initiate treatment for children with acute malnutrition before they become seriously ill. Caregivers provide treatment for the majority of children with acute malnutrition in the home using Ready-to-Use Therapeutic Foods (RUTF)* and routine medical care. When necessary, severely malnourished children who have medical complications or lack appetite are referred to in-patient facilities for more intensive treatment. CMAM programs also work to integrate treatment with a variety of other long-term interventions. These are designed to reduce the incidence of malnutrition and improve public health and food security in a sustainable manner.

The CMAM model was developed by Valid International and has been endorsed by WHO and UNICEF. CMAM was originally designed for the emergency context, as an alternative to the traditional model of rehabilitating all severely malnourished children through in-patient care at Therapeutic Feeding Centers. However, it is increasingly being implemented in the context of long-term development programming, with several Ministries of Health including components of CMAM in their routine services.

CMAM has been implemented around the world by many governments and NGOs.