A Sociocultural Perspective on Malnutrition in Children: Evidence from POSHAN Programme, Rajasthan

Integrated Management of Acute Malnutrition or POSHAN Phase 2.0 was implemented in 20 districts of Rajasthan in 2018. After 12 weeks of outpatient therapeutic care of children with Severe Acute Malnutrition (SAM), 70.4% children were cured, 12.2% defaulted and 17.4% were non-recovered and referred to Malnutrition Treatment Centres for facility treatment. The research study attempts to (a) study the sociocultural factors at the family level responsible for varying numbers of cured, defaulted and non-recovered SAM children at different localities; (b) explore the probability of the SAM children staying healthy post successful treatment at community settings without any external intervention; and (c) explore the possible approaches beyond the emergency medical response to develop a long-term strategy to address malnutrition in children. The insights and cues gained from the phenomenology of individual experiences help us understand the structural elements that undergird a healthy living. It was observed that irrespective of socio-demographic characteristics and food basket of a family, all the SAM children had a troubled medical history and/or low birth weight. The research findings also point out that a rise in income alone does not automatically lead to increased nutritional food intake. It is also important to see the issue of malnutrition in the larger context of the agrarian crisis that has cast its shadow over the rural landscape. For sustainable and lasting solutions, it is essential to shift to and promote farming practices that facilitate indigenous, locally produced and culturally acceptable nutrition from supplementary foods.

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Development and Acceptability of Locally Made Fish-Based, Ready-to-Use Products for the Prevention and Treatment of Malnutrition in Cambodia

Food and Nutrition Bulletin ◽

10.1177/0379572118788266 ◽

2018 ◽

Vol 39 (3) ◽

pp. 420-434 ◽

Cited By ~ 8

Author(s):

Sanne Sigh ◽

Nanna Roos ◽

Daream Sok ◽

Bindi Borg ◽

Chhoun Chamnan ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Treatment Intervention ◽

Intervention Trial ◽

Overall Acceptability ◽

High Prevalence ◽

Prevention And Treatment ◽

Moderate Acute Malnutrition ◽

Hedonic Scale ◽

Supplementary Foods

Background: Cambodia has a high prevalence of moderate acute malnutrition and severe acute malnutrition (SAM). The SAM treatment requires ready-to-use therapeutic foods (RUTFs), whereas ready-to-use supplementary foods (RUSFs) are used for prevention of acute malnutrition. Three locally produced fish-based products were developed: an RUTF paste (NumTrey-Paste) for treatment and 2 wafer versions, one for prevention (NumTrey-RUSF) and one for treatment (NumTrey-RUTF). Objective: To assess the acceptability of NumTrey-Paste and NumTrey-RUSF in comparison to a standard biscuit product (BP-100) used for the treatment of SAM. Methods: Acceptability of NumTrey-RUSF and NumTrey-Paste was tested in a nonblinded crossover taste trial among children (n = 52), aged ≥ 6 months to 18 years, and their caregivers. Eight organoleptic qualities were assessed on a 5-point hedonic scale, as well as a ranking test. A score of 1 to 3 was categorized as acceptable. The acceptability of NumTrey-RUTF was assessed using the caregivers’ perception during an SAM treatment intervention. Results: Taste trial: The proportion of children categorizing products as overall acceptable was lowest for NumTrey-Paste compared to for BP-100 and NumTrey-RUSF (21% vs 43% [BP-100] and 36% [NumTrey-RUSF]). No difference was found in the proportion of children who ranked BP-100 or NumTrey-RUSF as “liked most” ( P > .05). Acceptability of NumTrey-RUSF ranked highest in appearance and taste (caregiver), whereas acceptability of NumTrey-Paste was ranked lowest in appearance and smell among the products. Intervention trial: The acceptability of NumTrey-RUTF increased from 72% to 86%. Conclusions: The overall acceptability was ranked lowest for a pure paste product. However, filling the paste into a wafer made the product more acceptable.

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Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15091807 ◽

2018 ◽

Vol 15 (9) ◽

pp. 1807 ◽

Cited By ~ 4

Author(s):

Stefania Moramarco ◽

Giulia Amerio ◽

Jean Kasengele Chipoma ◽

Karin Nielsen-Saines ◽

Leonardo Palombi ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Integrated Management ◽

International Standards ◽

Acute Malnutrition ◽

Child Malnutrition ◽

Average Weight ◽

Community Based ◽

Predictors Of Mortality ◽

Feeding Programs ◽

Treatment And Prevention

Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.

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Community-Based Management of Acute Malnutrition for Infants Under 6 Months of Age Is Safe and Effective: Analysis of Operational Data

Public Health Nutrition ◽

10.1017/s1368980021004894 ◽

2021 ◽

pp. 1-27

Author(s):

Maeve M. Woeltje ◽

Anastasia B. Evanoff ◽

Beth A. Helmink ◽

Diana L. Culbertson ◽

Kenneth M. Maleta ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Community Based ◽

Malnourished Children ◽

Nutritional Recovery ◽

Economic Barriers ◽

Moderate Acute Malnutrition ◽

Supplementary Foods ◽

Operational Data

Abstract Objective: To assess the effectiveness of outpatient management with ready-to-use and supplementary foods for infants under 6 months (u6m) of age who were unable to be treated as inpatients due to social and economic barriers. Design: Review of operational acute malnutrition treatment records. Setting: 21 outpatient therapeutic feeding clinics in rural Malawi. Participants: Infants u6m with acute malnutrition treated as outpatients because of barriers to inpatient treatment. The comparison group consisted of acutely malnourished children 6-9 months of age who were being treated at the same time in the same location in the context of two different randomized clinical trials. Results: A total of 323 infants u6m were treated for acute malnutrition (130 severe and 193 moderate). A total of 357 infants 6-9 months old with acute malnutrition (74 severe and 283 moderate) were included as contemporaneous controls. Among infants u6m with severe acute malnutrition, 98 (75.4%) achieved nutritional recovery; in comparison, 56 (75.7%) of those with SAM 6-9 months old recovered. Among infants u6m with moderate acute malnutrition, 157 (81.3%) recovered; in comparison 241 (85.2%) of those aged 6-9 months recovered. Conclusions: In a rural Malawian population of infants u6m who had generally already stopped exclusive breastfeeding and were now acutely malnourished, treatment with therapeutic or supplementary foods under the community management of acute malnutrition model was safe and effective. In settings where social and financial factors make hospital admission challenging, consideration should be given to lowering the recommended age of ready-to-use therapeutic and supplementary foods to infants u6m.

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