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Community-based management of severe malnutrition: SAM and SUW in the tribal area of Melghat, Maharashtra, India

Ashish Rambhau Satav

1. To achieve recovery rate of 75% in severe acute malnutrition (SAM) children and 35% in severe underweight (SUW) children, in tribal community. 2. To achieve case fatality rate of <4% in SAM and SUW children in the above setting. 3. To reduce current prevalence rate of SAM and SUW by at least 35% in above setting. Design: Community-based prospective, single-group intervention study. Setting: Primary and secondary care was given to participants from 14 villages of Melghat tribal area. Participants: Severely malnourished children (SMC:734), tribal, male and female of the 6–60 months age group were enrolled and 680 children completed the study over a period of 3 years. Sample size (N = 762) was estimated considering the prevalence of severe malnutrition (SAM and SUW) in 6–60 months population as 21.5%; design effect was 3.0 and relative precision was 10%, with 95% con?dence interval. Interventions: LTF (local-therapeutic-food) with MN (micronutrients), treatment of infections and BCC (behaviour change communication) were given for 90 days to SMC by VHW (village health worker). Outcome Measures: Rate of recovery, case fatality rate, and reduction in prevalence of SAM and SUW. Results: Recovery rate of SAM is 75.9%, 77.8%, and 79.4%; and recovery rate for SUW is 37.5%, 42.7%, and 45.4%, at end of 8th, 10th, and 12th week, respectively. Case fatality rate for SAM is 0.6% and for SUW is 0.2% after 8th week. There is a signi?cant reduction in prevalence of SAM ( p – 0.005) and SUW ( p – 0.0001) children at end of the study. Conclusions: The study shows ef?cacy of LTF-MN and effectiveness of our community-based model in acute and chronic malnutrition. Further research is needed for deciding the exact duration of SUW therapy.