By: Manita Jangid, Sangita Jacob, Shikha Wadhwa
Bharat’s mother cuddling his frail body in her arms traveled from far flung Luni block in Jodhpur district to the District Hospital, referred by an Anganwadi worker. One look at the child and the doctor said “Take him straight to the Malnutrition Treatment Centre (MTC), and you will get immediate care all free of cost for your child.”
The mother hurriedly walked towards the MTC for the child’s checkup. The child was immediately assessed for weight, height, signs and symptoms and the gravity of infections.
Astonished by the state of the child, the paramedical staff told Bharat’s mother, “Your child’s weight is abysmally low in comparison with height and age i.e. 4.5 kgs. He is severely malnourished with extreme muscle wasting and this is a state of medical emergency. He needs to be immediately admitted”. Although worried by the diagnosis, the immediate attention and care provided to her son comforted the mother a great deal.
Bharat was put on antibiotics treatment and put on a special therapeutic diet, prepared in the attached kitchen.
According to National Family Health Survey (2005-2006) in Rajasthan, 44 percent of the children under the age group of 3 years are reported to be underweight (too thin for age).
Within a day, Bharat’s condition visibly improved. Paramedical staff tried to ascertain from Bharat’s mother the reason for the child’s condition. She said, “We belong to a small hamlet and due to lack of resources, I have been engaged in farming leaving my child at home. He was neither given colostrum nor exclusively breast fed.”
The mother added, “I have not started giving any sort of solid or semi solid food to my child as he is too small to eat. Since most of the time I am away in field, Bharat is given cow’s milk”.
It was clear that lack of knowledge had plunged the child gradually into the vicious cycle of malnutrition and then the situation went out of control. It was only then that Bharat’s mother sought medical assistance. He was provided cereal based therapeutic feed (F 75 feed; locally constituted mix providing 75 calories) for the first two days. During the next three days, an egg based formula diet was given to the child.
Eventually during the period of recovery at the MTC, Bharat’s mother was counseled regarding correct feeding practices and care. Finally on the ninth day, para medical staff assured Bharat’s mother, “Now Bharat has regained significant weight and is recovering fast. He has a better appetite and weight gain.”
Bharat was finally discharged on the 9th day and received continuous support from the anganwadi workers, in his home. He is now healthy and growing well.
Key Milestones of MTCs
· 9 MTCs set up in Rajasthan: Seven in District Hospitals and two MTCs at Community Health Centre
· 2000 children treated till date
· Average weight gain at the MTC- 460grms
· Average Duration of Stay at MTC- 9 days
· Mortality rate while hospitalized – 0
· Mortality post discharge- 1 %
In December 2000, the Rajasthan Department of Women and Child Development, and UNICEF jointly initiated Anchal Se Angan Tak (ASAT) strategy as a community based care model in seven districts viz. Jodhpur, Tonk, Dholpur, Alwar, Rajsamand, Baran and Jhalawar.
Under ASAT, Special Plan of Action for Management of Severe Child Malnutrition was initiated in 2005 in 14 blocks of seven districts using WHO standards based on a two pronged strategy viz. Hospital Based and Community based.
The Department of Medical and Health Services, Department of Women and Child Development, Government of Rajasthan, and UNICEF took the lead in addressing acute undernourishment in children, by operationalizing Malnutrition Treatment Centres (MCTs) as a pilot initiative.
Anganwadis have also been trained in adopting WHO protocols. The activities at the angawadis are (i) on going mapping of severely malnourished children in village, (ii) regular weighing of children with involvement of mothers, (iii) tracking and listing, referral services, home visits by Anganwadi Helpers, (iv) special visits to the homes of the children discharged from MTC, and (v) involvement of community volunteers. Children falling in Grade III and IV of malnutrition are monitored for signs and symptoms of infections and referred to Public Health Centres, FRU or Community Health Centres for treatment.
Till date, more than 2000 malnourished children have been treated at the MTCs. The success of the initiative and positive outcomes have led the Government of Rajasthan to announce the replication of the model in all 32 districts.