Tackling Severe Acute Malnourishment During COVID-19

The Global Hunger Index ranks countries on measures of malnutrition in children. It places India at 102 among 117 Countries in its last report (GHI 2019). This position was a significant drop from 63 in 2013, and 55 in 2014. This score puts forth the alarming truth about the hunger problem in our country, despite recent improvements in food systems and their availability. A large number of children are still suffering from Severe Acute Malnutrition (SAM).

The economic decline and rise of internally displaced people (IDPs) due to the ongoing COVID-19 crisis will only make matters worse. A displaced population is mostly reliant on food-aid, which has a risk of being deficient in key nutrients. Furthermore, lack of hygiene and safe water elevates the risk of getting affected with diseases like diarrhea, measles and malaria, which aggravate SAM conditions. Pregnant women, lactating mothers and children below 5 years of age are the most vulnerable in the population.

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Although Government and civil agencies have implemented commendable welfare programs for emergency aid, their focus now must be on providing nutrient dense foods too. For example, instead of providing raw materials, it might be more effective to provide cooked or prepared food, that are fortified with the right nutritional amount. This is possible through various Self-Help groups at the ground level which can be mobilized to boost employment opportunities.

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Despite goodwill initiatives and interventions from global and national agencies (GO’s, NGO’s, CSR etc), we are yet to see a huge dent on malnutrition. We need to introspect on why these efforts are not able to deliver the desired results. We need to change focus from just running on-going conventional blanket feeding programs (SFP, MMP, THR etc.) to uprooting the root cause factors holistically.

The root causes of malnutrition in India, ranging from problems with nourishment during the first 1000 days, health care, personal hygiene, sanitation, water etc., vary across geographical barriers. The commendable work carried out by front line workers such as ASHA/AWW has brought a decline to many undesirable food habits (such as pre-lacteal feeding), food fads and taboos but there is a long way to go to completely address these problems.

Even though the prevalence of malnutrition has declined over the last decade, the Comprehensive National Nutrition Survey 2016-18 (CCNS) has highlighted several challenges. Still approximately 20 million under five years children are wasted and more than half Indian women in their reproductive age groups are anemic. This is the scenario before the pandemic, after COVID crisis the situation will only aggravate this public health problem of malnutrition.

Improving household food security with safe, affordable, accessible and acceptable foods can counteract nutritional vulnerability immensely. Improper applied knowledge of caregivers/mothers in underprivileged societies, in terms of food, hygiene, sanitation, safe water and immunization are factors which lead to all forms of malnutrition.

Multi-sectoral initiatives should be used to build long-term capacity and to make efforts more sustainable post pandemic. This can be done efficiently by harnessing community resources, introducing behavioral changes, and community sensitization. For example, screening of SAM children using the Mid Upper Arm Circumference (MUAC) method, which is age independent, and referring the child to the nearest hospital/PHC/NRC needs to be implemented efficiently. Target weight for discharged children as per WHO (2009) guideline should be strictly adhered, intense monitoring of Nutrition Rehabilitation Centers’ (NRCs) for basic service provision and hygiene and infection control protocols need to be followed stringently. Support for ongoing government initiatives of screening the undernourished and feeding them as per laid Govt. programs, enforcing distribution of quality food supplements particularly for Take Home Rations (6m-36m) to avoid sharing by others at home, reinforcing sustainability of normal health status after recovering from SAM/MAM stage, irrespective of economic background and lastly political and administrative will to engage rapid response strategies for mobilizing food aid and managing mother and child care for up to 1000 days and children up to 5 years, needs to be brought together holistically.

Like all multi-sectoral strategies, these strategies too require immense motivation from both the frontline workers and local administrative bodies, especially in these crucial times to avoid another silent disease outbreak with a pandemic potential. A call for adhering to Community based Management of Acute Malnutrition (CMAM) is the priority. Community specific guidelines focusing foods (selection/ preparation), feeding, sanitation (personal/environmental) and infection control/management protocols should receive attention and action in any helping ventures.

It is only when all stakeholders take the necessary collective action to address malnutrition in India, will this silent crisis be managed on time and will prevent precipitation.

(The author is a consultant nutritionist)