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Community Based Management of Acute Malnutrition (CMAM)

N.M. BUDHRANI-DOCTORS FOR YOU RURAL HEALTH CENTRE, VILLAGE MASARHI, PATNA, BIHAR, INDIA

Bihar has one of the worst child health indicators with 43% children being underweight, 48% stunted, 53 % being exclusively breastfed for 6 months and only 7 % children getting adequate complementary feed between 6-23 months (NFHS-4). Moved by these indicators, we started a community based programme for malnutrition management.

What is CMAM?

cmam

Currently the only direct intervention for Malnutrition by the Indian govt system is provision of rice and pulses as ration for malnourished children and admission of malnourished children with complications in NRC (Nutritional Rehabilitation Centres). This is a highly inadequate response as NRC leaves out SAM (severe acute malnutrition) and MAM (moderate acute malnutrition) children without complications. Also the ration provided by government to malnourished children gets invariably consumed by family members. Hence world over there is a move towards CMAM. The rationale is that maximum malnourished children can be managed at home with therapeutic foods and empowering mothers with right knowledge about feeding practices.


Currently we are the only running CMAM programme of the state


COMPONENTS:

IYCF
  • Nutritional Supplementation
  • IYCF Counselling
  • Emotional stimulation through play in toy room

The TEAM

Being in a remote area with poor accessibility, recruiting qualified manpower was a real challenge. Keeping longterm sustainability in mind we trained eight housewives with basic literacy in taking accurate anthropometric measurements, preparing nutritional supplements and providing IYCF counselling. After initial direction by a doctor, the whole programme is now run efficiently on the ground by these women under supervision of a trained nurse.


The Screening Tools For Diagnosing SAM and MAM

sam-mam-weight-diagnosis

  • Weight
  • Height
  • Growth charts (Weight for height)
  • MUAC (Mid Upper Arm Circumference)


The Protocol

  • Home Based Management for SAM and MAM without complications
  • Indoor management of SAM and MAM with complications(pneumonia/Diarrhoea etc)
RUTF

SAM : One week supply of RUTF (Ready To Use Therapeutic Food). This is purchased and given as per body weight along with a course of antibiotics, Deworming and Vitamin A supplementation.

MAM : One week supply of Hyderabad Mix. It is a nutritional supplement made locally by women from locally available, culturally acceptable foods like wheat flour, bengal gram flour and ground nut powder. All are roasted together in ghee. This is given in measured amounts with jiggery along with micronutrient supplements.


MUAC Follow Up: Weekly weight and MUAC is monitored

Time to Achieving ‘CURE’: Usually 2-3 months

Results: (March ’16 to Sept ’16)
Total children screened: 411
SAM: 74, MAM: 99
Total SAM and MAM under treatment: 84
SAM to Normal: 10, MAM to Normal: 23, SAM to MAM: 5

On a Personal Note: Treating malnourished children gifted us few of our most satisfying career moments. The transformation of children was beyond just weight gain. The sensory-neural development was the real delight to see. Kids of 1 and half years who would not walk started gaining all their pending milestones within weeks! Kids who would fall sick every couple of weeks remained disease free for months! Biggest example is Baby Khushi, Age: 18 months (SAM). Her story is as follows

SAM

We are guilty of many errors and faults,but our worst crime is abandoning the children. Many of the things we need can wait. The child cannot.Right now is the time his bones are being formed, his blood is being made and his senses are being developed. To him we cannot answer ‘tomorrow’. His name is Today’....
- Gabriele Mistral