Combating severe malnutrition: Lessons from Rajasthan

prasad1 · Mar 14, 2020

In the national health index released by NITI Aayog in 2019, Rajasthan has emerged as one of the top two states, which is making the most progress on healthcare indicators between 2015-16 and 2017-18. This assessment is based on strides on many indicators, that include reduced death-rates of newborns and children under five years of age, a falling share of low-birthweight babies, a surge in immunisation rates, and percentage of babies born in hospitals rather than homes. All these indicators have one thing in common - improvement in child health.

There is another area, where emerging evidence, though still in early stages, is showing that Rajasthan is scripting a success-story---in healing its children who are found severely malnourished. Children suffering from severe acute malnutrition (SAM) are eleven times likely to die, and lack immunity towards infection and diseases.

In attempting to cure children suffering from SAM, Rajasthan took the help of an approach that the world had learnt from humanitarian emergencies of Africa in 2000 -- called Community-based Management of Acute Malnutrition (CMAM). Once found effective in managing SAM children, it was adopted as a standard approach by the United Nation (UN) agencies in 2007 in emergency and developmental contexts. Two years later, Médecins sans Frontières, an international humanitarian agency, partnered with the Bihar government, to use this as an emergency response to manage SAM children in Bihar during Kosi floods, and found a dramatic recovery rate of 88.4%. Since then, this evidence-based decentralised approach of CMAM has been implemented in more than 70 countries to manage and treat children under five with acute malnutrition.

Combating severe malnutrition: Lessons from Rajasthan

It is the urgent need of the hour that we create a formal mechanism to measure and share the evidence from all states so that we can learn from each other and give a future of health to our children

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prasad1 · Mar 14, 2020

To the shock of the public health community, in July 2019, the National Nutrition Mission reported that out of the total allocated funds for the year 2018-19, the states had utilized only 22 percent. This poor utilisation of allocated funds for the management of the malnutrition problem indicates lack of prioritising, planning and use of funds.

But is this acceptable in a country where international journals estimate that 68.4% of all child deaths can be attributed to various forms of malnutrition? Even our own national surveys, show that about 38.4% of our children under the age of five are stunted, 35.8% are underweight, 21% are wasted and 7.5% are severely wasted. Startlingly, in the last decade, severe wasting has increased from 6.4% (2005-06) to 7.5% (2015-16) in India, as per the National Family Health Survey.

It is the urgent need of the hour that we create a formal mechanism to measure and share the evidence from all states so that we can learn from each other and give a future of health to our children, that is not only our duty but also their right.