ABSTRACT
Malnutrition is a major public health problem in most developing and underdeveloped countries. While it contributes to 50% of under-five mortality (U5M), the survivors too face long-term implications like reduced educational outcomes, lower economic productivity, and an increased risk of non-communicable diseases later in the later phase of life. India has a heavy burden of malnutrition. According to the NFHS-5 report, under-five children with stunting accounted for a staggering 36%, followed by 32% of underweight and 19.3% of wasting in 2020–21. Chronic malnutrition (SUW and severe stunting) is 2.5–3 times higher than acute malnutrition (SAM). The Sustainable Development Goals (SDGs) call for an end to all forms of malnutrition by 2030. While there exist government programmes like the Poshan Abhiyan to address this challenge, significant issues persist. There is a high mortality risk (4–9 times), paucity of scientifically sound community-based studies and absence of comprehensive guidelines for community-based management of malnutrition, which underscores the need for innovative solutions. Community-based management of malnutrition can be critical in bridging the gap for India to achieve SDG target 2.2.
‘MAHAN’ study reveals an effective integrated innovative community-based approach for addressing malnutrition in Melghat. Melghat is a difficult-to-access, hilly-forest region in Maharashtra, characterised by the dominance of the tribal population. The ‘COREM intervention’ is a multi-pronged approach with active community participation for community-based management and prevention of malnutrition and child mortality. Based on focus group discussions (FGDs) and surveys conducted in the region, we conducted cluster randomised control trials (CRCTs). The interventions included a ‘home-based childcare programme’ for the treatment of infections, home-based newborn care, antenatal care, nutritional therapy with locally prepared therapeutic food with micronutrients, and behaviour change communication (BCC) for under-five children (U5C). We also undertook additional support initiatives, such as counselling programmes for strengthening government hospitals, setting up nutrition farms and water conservation mechanisms, and using tools like advocacy, government collaboration, and PIL to enhance nutritional outcomes. The results were overwhelmingly positive, with a reduction in severe malnutrition from 23.97% to 9.5% (p-value <0.001) and U5MR declining from 147.21 to 40.53 per 1,000 live births (p-value <0.001). Follow-up of severely malnourished children (SMC) at the age of five years in the treatment group showed growth patterns and mortality rates similar to those of normal control group children. Our interventions are cost-effective, socio-culturally more acceptable, community-centric, and easily replicable in other regions. Thus, the insights gathered from this study can be useful in designing and implementing future health initiatives aimed at addressing malnutrition and mortality in a resource-constrained setting. The chapter underscores the importance of holistic community-centric local solutions along with strong public patient involvement (PPI) and long-term follow-up in addressing malnutrition. MAHAN's COREM model serves as a guiding framework for future endeavours, advocating for collaboration, evidence-based strategies, and a focus on long-term impact for improved health outcomes.
