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Saving twins from the clutches of malnutrition
" ECHO-supported CBDRR initiative by UNICEF in Bihar "

ECHO-supported CBDRR initiative by UNICEF in Bihar

By Aditya Malaviya

PATNA, BIHAR: Puja and Arti are seven-month old twin sisters born to Sabita and Hari Giri living in the small village of Madhubani Ghat in East Champaran district of the North Indian state of Bihar.

Madhubani Ghat is a non-descript village located very near to the confluence of Buri Gandak and Dhanauti rivers, which originate in the Himalayas. As a result, it is highly vulnerable to regular floods.

Both Sabita and Hari belong to a socially excluded community, and given that they are illiterate and have had little contact with the outside world, they lack information and support to bring up their children as healthy individuals.

Indu Jha is one of the forty village motivators trained in flood mitigation as part of the Early Recovery Programme for Flood Mitigation supported by UNICEF and the European Commission Humanitarian Office (ECHO).

As a part of the programme, young children in the district were screened for severe acute malnutrition (SAM). Efforts were made to build the capacity of community mobilisers and volunteers to address SAM.

That was the time when Indu first visited the twins and Sabita. Using the mid upper arm circumference (MUAC) tape, Indu determined that the twins were SAM cases. She immediately advised their parents to take both of them to the Nutrition Rehabilitation Centre (NRC) at the district headquarters for treatment.

During the entire process Indu was always by their side, supporting the parents and facilitating the admission of the two girls to the NRC, where they were treated for 14 days. Children with SAM need special treatment along with therapeutic feeding, and sound hygiene practices.

At the time of admission, the weight of both children was 4.5 kilos, while their MUAC read 105 mm - well below the SAM cut-off of 115 mm (as per the WHO and UNICEF recommendation).

As a result of the treatment received by the twins at the NRC, the severity of their malnutrition was notably reduced, with Puja gaining a kilo and Arti gaining 1.6 kilos in two months’ time. Similarly, the MUAC reading for both the girls increased up to16 mm, indicating their improved nutritional status.

Indu continued her follow-up with the twins in their post-NRC period to make sure that Arti and Puja did not lapse back into SAM. Feeding demonstrations and counselling using pictorial flip books and instituting remedial measures along with the provision of basic curative services through her nutrition-health kit (e.g. diarrhoea treatment with ORS), Indu helped mothers realize the benefit of the health and nutrition services available to them. It further motivated them to avail these services. 

With the on-going Integrated Child Development Services (ICDS) programme in place in their village, the twins were registered at an Anganwadi centre to avail a range of health and nutrition services offered. 

Community volunteers too were identified to ensure regular follow-up of the children for utilizing services such as supplementary feeding, monthly weighing for growth monitoring, immunization, and timely treatment for diarrhoea. 

Home visits and repeated counselling sessions and demonstrations have empowered families of Madhubani Ghat to take on improved practices related to cooking, feeding, managing diarrhoea and caring for the children, which can go a long way in fighting malnutrition at the household level. 

The Government of Bihar along with UNICEF and other development partners is making an active and dedicated effort to ensure progress towards improving the health and nutritional status of children in the State in a sustainable manner.

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