KARUNA-SHECHEN INDIA BASE-LINE SURVEY ON ACUTE MALNUTRITON OF CHILDREN UNDER 5 YEARS IN SIX SELECTED VILLAGES OF DISTRICT OF GAYA, BIHAR

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1 KARUNA-SHECHEN INDIA BASE-LINE SURVEY ON ACUTE MALNUTRITON OF CHILDREN UNDER 5 YEARS IN SIX SELECTED VILLAGES OF DISTRICT OF GAYA, BIHAR Abstract. In February 2013, a baseline survey on acute malnutrition of children under 5 years has been done in six villages of the district of Gaya. On 460 children measured with anthropometric tool MUAC - Middle Upper Arm Circumference-acute malnutrition has been discovered in 6.8% of the children. Only 0.2% were severely acute malnourished. Evaluation of the acute malnutrition status of 650 children under 5 in six new villages supported by Karuna-Shechenin India: Banda, Dema village, Dema 4 tolas, Kadal, Barsudi, Chando, Nawartari, Meghubigha tola The official average of the level of acute malnutrition in the district of Gaya (HUNGaMA survey 2011) is 13.6%. The reason of a lower rate during this survey could be explained by two reasons: I) The month of February is not a period of shortage of food and of high infection in childhood disease. ii) The sample of 460 children was too small to find a higher %. The survey must be repeated from May to September 2013 by the same team when shortage of food is there as well as higher risk of childhood infection. The relevance of a nutrition program can only be sort out after monsoon season according to the results of the second base-line survey on acute malnutrition in the same villages. Base-line survey on malnutrition, DR. Nadine Donnet Consulta Page 0

2 Base-line survey on acute malnutrition of children under 5 years old in 6 new villages of district of Gaya Banda village, name of the child, age, MUAC 11,5cm, severe acute malnourished child Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 1

3 Same child Bandha village, name, age ect This report is dedicated to the mothers of the 18 villages that Karuna-Shechen support since many years, to the army of social workers such as doctors, nurses, village coordinators, motivators, Anganwadi workers and other government functionaries engaged in this movement against child malnutrition. This report is the collective effort from Managing Director Karuna-Shechen India, Shamsul Akhtar who made it happen, to all staff of Shechen clinic, in particular Rakesh Kumar/ village Coordinator, Rusenara/ nurse, driver Deepak who joint me on this survey. A special thanks go to Rakesh Kumar, Village Coordinator, for his dedication and precise work on selecting the children under 5 years and prepare the lists and to nurse Rusenara who measured all the children with patience and precision. We hope this survey will serve as the basis for a joint action plan that Karuna-Shechen will adopt in order to bring about dramatic change in the nutrition profile of the children/mother of the villages. To all of them our heartfelt gratitude. Finally, we owe our deepest thanks to the villagers who have been so cooperative and helpful to show us the homes with children under five, to the mothers who opened their doors and to 650 children who accepted the measurement of Middle Upper Arm Circumference (MUAC). Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 2

4 We hope our efforts do justice to their hospitality. Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 3

5 Geography of the survey, localization of the six villages In the State of Bihar The base-line survey is located where Karuna-Shechen organization is developing its activities, in Bihar, District of Gaya. Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 4

6 In the district of Gaya In blue the new six selected villages where base-line survey took place in February 2013 Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 5

7 Objectives of the survey Primary objective To measure the prevalence of acute malnutrition of children less than five years in the six new villages that Karuna-Shechen support since February 2013, with a special attention to the severe acute malnutrition in order to evaluate the relevance of a nutrition program in this villages. Secondary objectives 1. To train Karuna-Shechen s team on malnutrition treatment and good measurement practices of acute malnutrition with 2 different tools (Middle Upper Arm Circonference and Weight For height) 2. According to the survey result, to elicit a surveillance and treatment of acute malnutrition program on a community based in the six new selected villages and relate this issue to the mother and child health program in action since 2 years by KS in the same villages. The survey: focuses on children under five years old given the critical importance of nutrition in early life focuses on key indicators of malnutrition, enabling rapid survey implementation and results turnaround It gives a granular view of the variations across the six villages Survey results can be used for Advocacy to highlight a nutritional problem in villages and elicit a response Defining appropriate intervention Measuring change in nutritional status overtime to inform the evolution of the situation in relation to contextual factors(seasons) Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 6

8 Methodology of the survey 1. Determine the geographical area where villages are of same livelihood( 6 villages selected with the same poverty criteria) 2. Choose focus group of greatest nutritional support needs (children under 5 years) 3. Choose the measuring population assessment method(muac and or Weight For Height) 4. As acute malnutrition is a seasonal issue, analyze the data to get the prevalence at a time T (February 2013) and repeat the survey later in the year. 5. Evaluate the pertinence of a nutrition program according to results 6. Write a proposal and give budget per year The method chosen for this base-line survey to measure the children with acute malnutrition is Middle Upper Arm Circumference (MUAC) on universal selection for all the under 5 years children in the six new villages (650 children) It is a fast, simple and reliable tool used for first evaluation in communities. Reason of choosing MUAC tool instead of Weigh For Height: the time imparted to the base-line survey was too short to choose Weight/Height systematically. The team was also too small to cover a larger area. We could lead the base-line survey only in the six new villages as our program will be phasing out in 2013 and 2014 in the 12 initial operational villages. Remark: February is not a season of shortage of food so chance to find severe acute malnutrition is much less. It was the only time that Consultant could give to Karuna- Shechen for such survey. Before starting the base-line survey, Dr. Nadine Donnet, Consultant in Malnutrition, has provide one day training on malnutrition and given tools of measurement. The base-line survey lead in February is so more a training practice on anthropometric measurement to Karuna-Shechen team than a reliable base-line survey but it will serve as a first assessment on malnutrition in six of our villages. Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 7

9 Result of the base-line survey Village population Child < 5years abs measured MUAC < 11.5cm SAM MUAC < 12.5cm MAM Dema Dema/Tola Sarvarbigha Dema/Tola Marichbigha Dema / Tola Bangavala Chando Barsudi Kadal Nawatari Meghubigha Bangha Dema/Tola Laxmipur Total Children < 5 years measured Total children MUAC 11.5cm/ SAM Total children MUAC 12.5cm/MAM Prevalence of acute malnutrition (severe and moderated) in the six villages/tola during the month of February 2013 is 6.8% Severe acute malnutrition (MUAC <11.5cm) is 0.6% Moderate acute malnutrition (MUAC<12.5cm) is 6.2% Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 8

10 Recommendations 1. Repeat the same base-line survey in May/ June/ July/ August/ September as it is season of shortage of food and pic of infection and diseases, to have an accurate figure of the rate of Severe and Moderate Acute Malnourished children in our villages. 2. In the meantime, follow medically the children who have showed a MUAC< 12,5cm(31) with a particular attention to the ones who have a MUAC of 11.5cm(3). Give them deworming( mebendazole or albandazole)/take weigh/high of all those children (34) and follow twice a month the weigh. Keep the records on a special file. 3. Pay particular attention to babies (under 1 year) who are underweight, they are the focus group at risk to fall into acute malnutrition before 2 years old. 4. Wait the result of the second survey( September 2013) to define the final strategy that Karuna-Shechen could elicit for a nutrition program 5. Train the trainers -the KS staff :doctors, nurses, Villages coordinators- for an official training package facility based care of severe acute malnutrition at Ministry of Health and Family Welfare in Patna 6. Train some persons in the villagers to screen SAM in the villages ( Anganwari workers, motivators) 7. According to the results after second survey from May to June, two possibilities: a) If rate of SAM is still very low even during the shortage period of food, pic of infection and rainy season( < 1%) choose a surveillance program of SAM in the communities by the villagers helped by Karuna-Shechen team. i) identify the selected children with SAM thanks to MUAC and or oedema ii) * treat the children following the protocole UNICEF/ WHO and *use Easypaste (RUTF, based in New Delhi) in community if no medical complication and *follow up of the children nutritional state by our mobile clinic and field team + monthly follow up of weight/ height for one year after rehabilitation of the child. b) If rate of SAM reach 2% to 3% of the children < 5 years: open a more consistent program of identification and treatment of SAM with transfer of case of SAM with medical complication to NRC of Gaya and support this Centre. 8. Open a program of nutritional surveillance program of adolescent girls and women with BMI and even MUAC for adult for supporting nutritional status of such person identified as malnourished or underweight. This is the best Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 9

11 prevention possible of malnutrition of the children as a whole(both acute and chronic) 9. Treat anemia to such person( adolescent girls, women and pregnant women, children) 10. Set up a surveillance program of child under 2 years old for their nutritional status( MUAC/ weight For Height) Train human resource in the villages: Meeting with stakeholders to sensibilize on such issues and report to Karuna-Shechen mobile clinic team: community based approach of the problem. Train AWW(Anganwadi workers) to measurement of acute malnutrition. Train motivators and Village Coordinators 11. Repeat the base-line survey every 2 years during season of shortage of food and then follow the changes (indicators of results) and get indicators of results of the program. 12. Use eventually an annual follow up of the program from Expert/ Consultant. Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 10

12 Possible proposed action plan 1. Repeat the base-line survey from May to September( 5 months) 2. Send the result to Consultant Nadine Donnet 3. Set a program according to rate <1% or <2%( see recommendation) 4. Keep contact with UNICEF Patna/ ask UNICEF Patna and/or Ministry of Health and Family Welfare for some good training on Malnutrition for some of our staff 3 days training) 5. Select a Nutrition team amidst our staff who will identifies early screening of Severe Acute malnutrition/ SAM as well as Moderate Acute malnutrition children in the villages before the onset of medical complications. 6. Involve Motivators and Village Coordinators and doctors for the screening of SAM with MUAC and/or oedema during the mobile clinic and Village coordinators visiting the villages. 7. Two cases : i) The child is SAM with no medical complication, and then opens a program and start to apply the UNICEF/WHO protocole to treat SAM children in the communities. ii) The child is SAM with medical complication, send immediately to NRC Gaya and follow the child every week. iii) Medical complication are: poor appetite, visible severe wasting, oedema both feet, severe palmar pallor, anysick young child(<2months old),lethargy, drowsiness, unconsciousness, continually irritable and restless; signs suggesting severe dehydration in a child with diarrhoea 8. After treatment either in community or NRC, follow up thoroughly for at least one year each child cured of SAM. 9. Keep all data: selection, treatment and follow up. 10. Take good photos of child with SAM before and after treatment Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 11

13 Base-line survey on acute malnutrition in six villages in Bihar, District of Gaya, Dr. Nadine Donnet/Consultant Page 12