Innovative Solutions to tackle undernutrition

Samvardhan-An intervention to improve the Nutritional Status of Under 6 months old children in Purnea

The growth and development of children below 6 months of age are very fast and more rapid in the first three months of life. As per the WHO recommendation, a child should gain 800 to 900 gm weight and 3 to 4 cm height/length every month in the first three months of life. A child below six months of age has the potential to grow optimally if exclusively breastfed for the first six months.  As per the NFHS-5, wasting (weight for length) is highest among children below 6 months of age.

In Bihar, the moderate wasting rate is 31.4% and severe wasting is 15.1%   which is the highest among all age groups.  It is imperative to intervene in this age group not only to reduce neonatal mortality but also to improve the nutritional status of the children. 

UNICEF Bihar has developed a demonstration site in Purnea in partnership with the State Health Society (SHS) and Directorate of Integrated Child Development Scheme (ICDS), to demonstrate the Community Based Management of Acute Malnutrition (CMAM) program named SAMVARDHAN among severely wasted under-five children. Since February 2022, the intervention has started breastfeeding assessments among the mothers of low-weight babies and enrolled either the severely wasted or severely underweight children in the program. On an ongoing basis, the project staff and the frontline workers counseled the mothers and corrected the method of breastfeeding especially attachment and positioning.  From February 2022 to August 2022, a total of 115 mothers are assessed for breastfeeding and 37 children enrolled in the program who are either severely wasted or severely underweight. Many children become normal, and Kartick is one of them.

Stories of Hope

Counseling and support rehabilitated Kartick from the grips of malnutrition, in Bihar

Kartick at the time of enrollment: 2 March 2022, Weight: 2kg, Length:46.6 cm

Phulkumari a 23-year-old tribal lady is residing at Ganeshpur Panchayat of Krityanand Nagar block of Purnea district in Bihar. She delivered her second boy child named Kartick at home on 23 February 2022, assisted by a trained Auxiliary Nurse Midwife (ANM). The newborn was a low-birthweight child and weighed less than 2 kilograms. Initially, Kartick’s mother and the family member assumed that Phulmani does not have sufficient milk for the baby, and started giving him cow milk. At the time of the home visit, ASHA, and Community Based Management of Acute Malnutrition (CMAM) Project staff identified the issue. 

ASHA, Anganwadi Worker (AWW), and the CMAM project staff counseled the mother and family members on the importance of breastfeeding and the harmful effect of cowmilk on the newborn. AWW, and CMAM project staff assessed the breastfeeding technique of the mother. It was identified that the mother-child attachment and positioning were not correct and the frequency of feeding was also very low in numbers. At this juncture, the frontline workers taught her how to attach the baby, how to feed the baby, what would be the correct position, the importance of night feeding, etc.

Kartick as on 17 May 2022, Weight: 4.3Kg, Length: 55.6cm

Kartick was enrolled in SAMVARDHAN program on 2-3-22 with a 2-kilogram weight and 46.6 cm length when he was just 7 days old.  Kartick’s mother started practicing what AWW told her. Within 15 days Kartick gained 800 grams. This result gives confidence to the mother and family members. Kartick gained 2300 gm during two and half months and his length has increased by 9 centimeters during that time.

A Severe Underweight and Severe Wasted child becomes normal within two and half months with support from AWW and ASHA. Frontline workers and program staffs make follow-up visits to the enrolled children fortnightly and after discharge from the program, staff follows up with the children up to 8 months of age so that Complementary feeding is established.

It is evident that correct breastfeeding, not only improves the severely underweight or severely wasting status but it also affects the status of stunting.s leo.