Providing medical care for severe acute malnutrition in Jharkhand

© Nikhil Roshan

What We Do

India remains the country with the highest burden of childhood malnutrition in the world. In 2017, in collaboration with the government of Jharkhand and two renowned national academic institutions (RIMS Ranchi; JNU, Delhi) MSF initiated community management of acute malnutrition (CMAM) program in West Singbhum district of Jharkhand, a remote area with a high proportion of the tribal population. Aside from providing care to severe malnourished children, the project had an additional objective of generating contextual
specific evidence that would help address critical evidence gaps in India that have prevented wider state and nationwide implementation and uptake of CMAM. During the life of the project, which was wound down at the end of 2019, 2000 children with severe acute malnutrition were treated. 

The project included a multi-centre randomized, controlled non-inferiority process of care study for SAM children aged 6-59 months. This objective was to see if earlier discharge of children treated for SAM would be safe compared to existing recommendations; if shown to be possible, this would have substantial programmatic implications on CMAM introduction, potentially doubling the number of children that could be managed with the same resources.

Severe acute malnutrition is a medical condition that weakens the immune system and reduces the ability to fight off infection. This is why severely malnourished children have a much higher chance of dying from common childhood illnesses such as respiratory infections or diarrhoea. India has the largest burden of severe acute malnutrition in the world, with 9,300,000 children under the age of five affected. In 2017, in collaboration with the government of Jharkhand and national academic institutions, MSF initiated the Community Management of Acute
Malnutrition (CMAM) programme in the West Singbhum district of Jharkhand, a remote area with a high proportion of tribal people. As well as providing care to severely malnourished children, the project generated context-specific evidence to help address critical gaps in India that have prevented wider state and nationwide implementation of CMAM.

In 2020

Although our regular programme was discontinued in the first quarter of 2020, MSF continued to follow up on children with severe acute malnutrition who had been discharged from the programme until mid-year. As a member of the Technical Advisory Group of Jharkhand State Nutrition Mission, MSF contributed to shaping the state treatment protocol and has been working with district authorities to provide  sustained technical support to the health authorities to continue CMAM.

During the COVID-19 pandemic, MSF also provided technical input in developing emergency national guidance on the continuation and mitigation of CMAM programmes. The academic partnership also published the findings from a qualitative study; the findings will guide future community management of acute malnutrition initiatives from community engagement perspectives.

SAM children admitted
MAM children followed-up through ATFC’s
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