Experts Underline the Importance of Community based Approach in Addressing SAM

With malnutrition continuing to be a leading risk factor for death in children younger than 5 years, a webinar to address Severe Acute Malnutrition (SAM) held recently by industry chamber ASSOCHAM brought together top Government officials, public policy makers, public health experts and paediatricians together. Malnutrition accounts for 68.2% deaths in children under the age of five in India, says the Global Nutrition Report, 2020.

Webinar on SAM

“Malnutrition was still an epidemic in India, particularly for children, even before the pandemic struck. COVID-19 presents a danger of further slowing down decades of progress made in the area of malnutrition”, said Mr. Arun Mishra, Head, Global Nutrition Regulatory Affairs, Unilever & Co-chair National Food Processing Council, ASSOCHAM in his welcome address.

In his inaugural address, Mr. Naveen Jain (IAS), Secretary, Food, Civil Supplies and Consumer Affairs Department, Government of Rajasthan shared his hands on experience with the POSHAN Program in Rajasthan involving 10000 SAM children, one of the largest Community Management of Acute Malnutrition (CMAM) programs launched in the country.

“People in the villages were reluctant to bring malnourished children to the Malnutrition Treatment Centres (MTCs) as there was loss of daily wages for the attendants. Moreover, the responsibility of household chores was on the women which could not be fulfilled if they were to accompany the child in the care facility,” says Mr. Jain.

In association with GAIN, UNICEF and RUTF manufacturers, Mr. Jain in his capacity as Mission Director, National Health Mission Rajasthan launched India’s first significant CMAM program involving nearly 10000 children belonging to more than 1500 villages across 13 backward districts of Rajasthan. These children were provided EDNS for 2 months procuring products from CMAM Association members. The program proved to be very successful with a recovery rate of 75%. Moreover 95% children retained their healthy self and didn’t slip back to SAM after stoppage of EDNS.

Mr. Jain wondered why there was skepticism involving usage of therapeutic foods such as EDNS or RUTF in the country. According to him EDNS which was being manufactured with all the regulatory licenses and helping India earn foreign exchange by exporting to several countries was, unfortunately, not being freely welcomed in the country.

He appreciated the formation of CMAM Association of India as a key initiative and hoped to collaborate with the association in future health-based programmes.

Brig (Dr.) K Venkatnarayan, Officer on Special Duty, NITI Aayog shared a detailed presentation on the need for a holistic approach towards SAM. He mentioned a few challenges faced in facility-based care including uncomplicated MAM children being admitted at the NRCs, high opportunity cost for the parents, cost to the state, lack of adequate manpower, children being discharged before meeting the criteria etc. He emphasized on the need of multisectoral interventions to tackle SAM in a particular community. “It is important that Community based management of SAM is given importance for which national guidelines were under process,” he stated.

Dr. Alka Jadhav, Professor Pediatrics, In charge of Pediatric Gastro-enterology, LTMMC Sion Mumbai, stated that they had treated thousands of SAM children through RUTF. According to her, SAM children require 1620 Kcal every day. However these children have smaller stomach capacity and therefore cannot consume large volumes required to provide these calories and proteins in home cooked food therapies while 3 sachets of RUTF could serve the purpose. “RUTF should be taken for its medical nutrition therapy. Opposition to RUTF is not understandable since once treated, home cooked food is going to be the staple diet,” she stated.

Dr. Sujeet Ranjan, Public Health & Nutrition Expert, Ex-CNFS stated India had more than 8 million children below the age of 5 who have SAM. According to him, CMAM is the globally recommended approach for SAM. Given the scale of SAM burden in India, CMAM is the only way that many children can be treated, as facility based treatment at NRCs can address less than 1% of children with SAM.

According to Dr. A. Laxmaiah, Scientist, National Institute of Nutrition, “Evidence suggests that More than 90% of the SAM cases are without medical complications and can be successfully managed at home. Development of RUTF has made it possible to move away from a hospital based approach,” he said.

Mr. Arun Om Lal, Senior Vice President, Hexagon Nutrition and Co-founder, CMAM Association of India stated that CMAM Association of India had come into being to address a critical need of the hour. He exhorted all the stakeholders to join hands with CMAM Association to fight the scourge of SAM in the country.

Mr. Morten Hansen, MD, (Compact India Pvt. Ltd.), GC Rieber Compact AS and Co-founder, CMAM Association of India stated that India should be proud of its efforts towards eradication of malnutrition. CMAM Association members were involved in continued product development and conforming to the highest standards of product quality anywhere in the world. CMAM Association members were poised to support the Government of India in its drive to fight Severe Acute Malnutrition (SAM) in the country.

The session was moderated by Ms. Nirupama Sharma, Joint Director, ASSOCHAM.