Context: The covid-19 pandemic has disrupted optimal care for children, especially those who are malnourished, said a UNICEF report - Community based programme for children below 5 years of age with severe acute malnutrition in India - Progress so far and lessons learned 2020.
The United Nations International Children's Fund is a United Nations agency responsible for providing humanitarian and developmental aid to children worldwide. Its HQ is in New York, USA.
Malnutrition crisis in India:
- According to the Global Nutrition Report, 2020, malnutrition is the predominant risk factor for death in children younger than five years in every state in 2017, accounting for 68.2% of the total under-5 deaths.
- As much as 35.7% children under 5 years of age are underweight, 38.4% are stunted, and 21% are wasted, according to the National Family Health Survey-4 in 2015-16, conducted by the ministry of health and family welfare.
- As per the Comprehensive National Nutrition Survey (2016-18), conducted by UNICEF and the Ministry of Health & Family Welfare (MoHFW), 1 in every 20 children in India under 5 years of age suffers from SAM.
What is MAM and SAM?
- Globally, approximately 33 million children under five years of age are affected by moderate acute malnutrition (MAM), defined as a weight-for-height z-score (WHZ) between -2 and -3.
- Severe acute malnutrition is defined by a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional oedema.
Salient findings of the UNICEF report:
- Lack of guidelines: States were using their funds to roll out such programmes in select areas even as they were awaiting guidelines from the ministry of women and child development on community-based management of children with severe acute malnutrition (SAM).
- Barriers in the state-level Community Management of Acute Malnutrition (CMAM) Programme: Planned community activities are rarely implemented due to a lack of convergence between government departments, with proposed actors engaged in other activities.
- Data exclusion: List of children developed by Anganwadi workers are often used to identify children who need to be screened, yet they are often not complete.
- As a result, children living in more remote and hard-to-reach areas of the block can be excluded from routine screening.
- Inaccurate data: Screening equipment is often faulty and unusable.
- Weight and height measurements by Anganwadi workers and auxiliary nurse midwives are of poor quality, leading to inaccurate classification of children’s nutrition status,
- Vacancies: Many areas with fewer frontline worker vacancies have been chosen to ensure high quality service delivery. However, to scale up, vacancies will become a challenge.
Way forward: Coherent policy action, right from sectors such as health, nutrition, environment, urban and rural development, to education and finance, needs to be implemented at all levels with participatory approach.
- Community-based management programme: There is an urgent need to bring SAM management under essential health and nutrition services and to ensure continuity of services for the management of child wasting.
- One key mandate for Poshan Abhiyaan isto positively integrate and influence maternal child nutrition and well-being.
- For all this awareness and sensitization of local masses are extremely critical.
The POSHAN Abhiyan is a step in the right direction. Children should be given access to nutritious food to prevent malnutrition.
Community Based Management of Acute Malnutrition (CMAM)
- Unicef, with the help of government departments involved in child care, other stakeholders and NGOs, has launched Community Based Management of Acute Malnutrition (CMAM) and supply Ready to Use Therapeutic Food (RUTF) in the Indian states.
- As prescribed by UNICEF and the WHO, RUTF is the preferred emergency means of treatment of SAM children in the age group of 6 months to 5 years.RUTF is an emergency measure much like ORS for children at risk.
- Under the CMAM strategy, anganwadi workers (AWW) were particularly instrumental in active case finding, or proactively screening children to detect SAM cases.
Two primary challenges: one in relation to supply and logistics of therapeutic food (produced in India) sachets to remote parts and the other that over 41 per cent anganwadi centres (AWC) are inaccessible.
POSHAN abhiyan: The Prime Minister’s Overarching Scheme for Holistic Nutrition or POSHAN Abhiyaan or National Nutrition Mission, is Government of India’s flagship programme to improve nutritional outcomes for children, pregnant women and lactating mothers.
- It is a strategy for addressing malnutrition majorly focusing on the under-nutrition by adopting a life cycle approach.
- It is launched by the Ministry of Women and Child Development
- Its aim is to make India malnutrition-free by 2022.
- It aims to reduce stunting, under-nutrition, anaemia (among young children, women and adolescent girls) and reduce low birth weight by 2%, 2%, 3% and 2% per annum respectively.