Potentials, Experiences and Outcomes of a Comprehensive Community Based Programme to Address Malnutrition in Tribal India

This paper demonstrates the effect of an innovative community-based management programme on acute

malnutrition among children under three years of age, through an observational longitudinal cohort study in tribal blocks

in central-eastern India.

The key components of the programme include child care through crèches, community mobilisation and systems

strengthening to ensure better child feeding and caring practices and delivery of public health and nutrition services.

For a cohort of 587 children, the increase in children in the non-wasting category is from 72% to 80% (p<0.001) and the

reduction in Severe Acute Malnutrition (SAM) from 8% to 4% (p<0.005), a reduction of 46.6%. Normalcy is fairly well

maintained at 89%. Among the severely wasted, 16% show no improvement, 49% moved into a moderate wasting

category and 36% to normalcy over 4-6 months. Among the moderately wasted, 26% showed no improvement and 7%

declined to a severely wasted category, and 67% moved to normalcy. The average Weight for Height Z-score (WHZ) for

the cohort improved from -1.41 in the initial period to -1.13 in November (p<0.0001).

This study suggests that this medium term strategy using a rights-based participatory approach for community based

management of malnutrition may be comparatively effective by current WHO guidelines and other known community

based interventions in terms of mortality, cost, degree and pace of improvements