Severe Acute Malnutrition (SAM) is one of the hardest forms of malnutrition in children. There is increasing concern that COVID-19 will lead to an economic downturn and that current poverty will lead to a worsening of the countrys malnutrition levels. India currently has 9.3 million children under the age of five with SAM.
Webinar on SAM
Against this backdrop, Hexagon Nutrition Pvt. Ltd in association with ASSOCHAM (The Associated Chambers of Commerce and Industry of India) and Global Alliance for Improved Nutrition (GAIN) has taken this initiative to bring together the experts to formulate strategies in these unprecedented times via a Webinar, in particular, to prevent and control SAM across the nation. This Webinar focussed on Multisectoral Partnership to address Severe Acute Malnutrition during the Pandemic.
Mr. Arun Mishra, Head, Global Nutrition Regulatory Affairs Unilever & Co-chairman, Food Processing Council, ASSOCHAM in his opening remarks mentioned that the ongoing crisis of COVID-19 has affected individuals from all walks of life & it continues to affect us. This webinar will help us cope up with the crisis that has risen amidst the pandemic to find a way forward. The role of nutrition during this crisis is critically important for all age groups. As per the recent ICMR, RDA released only 5% of the rural population and 18% of the urban population of India gets the required protein which is an alarming fact.
Coming together cross-functionally and understand that different linkages or interlinkages of different ecosystems, acts, and stakeholders of the system can find a way forward to address the issue. Therefore, with this webinar, we hope to reach out to the Government of India with valuable insights and suggestions from this expert panel to solve this issue further.
Citing the real facts & speaking about his inspirational journey as Former MD, NHM, Govt. of Rajasthan, Mr. Naveen Jain (IAS), Secretary, Rajasthan Roadways, Govt. of Rajasthan mentioned that EDNS (Energy Dense Nutrition Supplement) and Malnutrition Treatment Centre (MTC) can make a huge difference in each state and district to eradicate SAM. An objective-based CMAM pilot in Rajasthan in association with GAIN, UNICEF, ACF, 4 EDNF manufactures and Community management of acute malnutrition (CMAM) children, has given a shred of evidence-based guiding direction to manage the CMAM for future research purposes. He also mentioned that MTCs & AAAs can be strategically based, institutionalized ways to eradicate SAM. Enabling mothers to take MUAC measurements themselves so that they can see their child getting better can be a major eye-opener.
Adding to this conversation Ms. Indira Mallo, (IAS) Commissioner, ICDS, Maharastra reminded us all with the fact that recent studies show that 85% of SAM cases can be treated through nutrition counseling and behavioral changes techniques, whereas the rest, 15% of complicated medical cases or with comorbidities might need deeper interventions. Here at ICDS under the campaign of Poshan Abhiyan, behavioral changes related to hygiene, sanitation, proper eating, family planning play a critical role.
Mr. Vikram Kelkar, Group MD, Hexagon Nutrition, showcased the industry perspective of SAM; speaking about malnutrition and its types, Global & Indian overview, he said that Asia & Africa bear the greatest share of all forms of malnutrition and that community-based management of CMAM is an integrated approach which on one hand focusses on treatment and the other hand prevention. To bring a significant reduction in the high incidence & prevalence of SAM, a multi-sectorial partnership along with mandate staple food fortification and providing micronutrient-rich food coupled with awareness of complementary feeding is required. He also stressed that as a way forward in addition to the above, standardized policies & national guidelines for treatment and the prevention of SAM children should also be implemented at a community level similar to what is existing for in facility management.
Elaborating SAM, Dr. Ranadip Chaudhary, Scientist, Society for Applied Sciences said that COVID-19 has brought about a surge in moderate and severe wasting among children below 5 rs of age. He also laid stress on the fact that as a community-based approach, all children with severe wasting & complications should be screened and assessed appropriately as per national guidelines.
Dr. Praveen Kumar, Director-Professor, Dept. of Paediatrics, Kalawati Saran Childrens Hospital shared a very focussed perspective on the management of nutrition rehabilitation centers during the COVID-19 pandemic. Sensitizing mothers and caregivers on essential nutrition practices during COVID-19 including COVID-19 related IEC, ensuring the availability of soap, sanitizers & cleanliness in NRC along with social distancing measures has led to successful management of SAM children. He strongly recommended that facility-based CMAM guidelines need to be put in place very soon so that the SAM problem can be addressed at a community level to all children who desperately need management.
Dr. Alka Jadhav – Professor Paediatrics & Incharge LTMG Hospital-Sion Mumbai highlighted that SAM is a Medical Emergency as India is home to 8 million children with SAM (31.2% of the world severely wasted children)
She popularized Nutrition Focussed Physical Examination for Diagnosing Malnutrition (NFPE) for diagnosing Malnutrition. She highlighted the RED FLAG signs so that early detection of SAM can be done and it can be arrested at an early stage by referring to the hospital. These Red Flag signs are: Age less than a year, Presence of Bipedal Odema & Failure of Appetite test.
Right from the stabilization phase to monitoring & rehabilitation of the nutrition status, she showcased how combinations of Milk Formula F-75 & F100 followed by Medical Nutrition Therapy along with Amylase Rich Food (ARF) and Home food are beneficial for management of SAM children.
Ms. Deepti Gulati, Head of Programmes, GAIN spoke about Poshan Project Rajasthan implemented by the National Health Mission (NHM), Govt. of Rajasthan, and supported by GAIN, UNICEF, ACF: Action Against Hunger & Tata Trust. This project gave a community overview of SAM management with a special focus on preventing under-nutrition, enhancing skills and development pathways of the front line workers. The Poshan (CMAM) project based on strict IAP-UNICEF-WHO protocols has proved that with proper screening, and implementation of MNT (Medical Nutrition Therapy, EDNS) along with strict monitoring, follow up & discharge protocols can help children recover from the swamp of SAM.
Mr. Tarun Vij, Country Director GAIN shared his concluding remarks that the Indian food industry is properly equipped to implement these kinds of programs & that we should not make our children, future generations anymore.
- A multisectoral Partnership can promote a continuous, secure & effective distribution of nutrition programs. As of now there are no dedicated policies for treatment and prevention of SAM at community level ; The panellists sincerely wished that the central/state government accepts the strategy & formulate guidelines for CMAM.
- All SAM children should be assessed for complications & uncomilicated SAM should be managed at a Community Level.
- EDNS or locally prepared nutrient-dense foods serve as an important ingredient for the special treatment of children affected by SAM while following the CMAM Approach. Thus, EDNS should not be understood as normal routine food. This can promote early identification of SAM and promt start of care.
- The key answer to reduce this healthcare burden is access to a nutrient-dense, safe and affordable diet for children.
- The scale-up of CMAM in conjunction with interventions that covers all forms of under nutrition.