Year 2017 ended on an encouraging note for the nutrition agenda in India with the approval by the Union cabinet for the National Nutrition Mission (NNM). The NNM envisions various activities, including the community based management of severe acute malnutrition (SAM) for children without medical complications as per guidelines that will be issued.
The debate which also flared up in 2017 on what to use to treat children with SAM at the community level has taken our attention away from the much broader set of measures that should and can be taken to address acute malnutrition in India. We need to put children with acute malnutrition at the center of a comprehensive approach addressing acute malnutrition. This approach includes four components.
1. Prevention of acute malnutrition
Overall prevention of malnutrition including improving infant and young child feeding practices needs to be scaled-up. Within a comprehensive approach addressing acute malnutrition there needs to be a specific focus on ensuring that children with Moderately Acute Malnutrition (MAM) do not develop SAM and that children that had SAM before do not get it again. Caregivers should receive targeted counseling, support and frequent monitoring of the nutritional status of their child.
2. Screening for MAM, SAM and referral
This is where community level support for children with MAM and SAM should start and in that light, it is worrying to see how few children are screened monthly for MAM/SAM through ICDS (Integrated Child Development Services), VHSNDs (village-health-sanitation and nutrition day), outreach and home visits. Routine screening needs to be urgently scaled up. At least 70% of children 6-36 months (the highest risk group) should be screened for acute malnutrition at least monthly with whatever agreed method for identifying MAM and SAM in children – possibly a combination of severe underweight, growth faltering, WHZ (weight for height) and/or MUAC (Mid-Upper Arm Circumference)
3. Facility based treatment of children with SAM and complications
A child with SAM and other medical complications needs to be referred to a health facility for treatment. A mechanism for referral already exist through a wide network of 1151 Nutrition Rehabilitation Centers (NRC) across the country.
4. Community based management of SAM
The majority of children with SAM don’t have medical complications and can be managed at home following standard protocols including antibiotics, deworming, weekly growth monitoring, counselling and energy-nutrient dense therapeutic, food provision and – in case complications develop referral to a NRC. It is expected that the community based management of acute malnutrition (CMAM) guidelines to be issued by the GoI will further guide on type(s) of therapeutic food. All the other essential components of CMAM are already quite routine interventions.
Every village in India has programmes being delivered through the platform of ICDS and Health. Thus, the infrastructure to deliver a comprehensive community-based programme to prevent and manage children with MAM and SAM already exists in India. Many other countries with large numbers of children with SAM do not have such infrastructure to deliver a comprehensive package.
So, let’s not wait any longer. Most of the components of a comprehensive approach addressing acute malnutrition in India are known and should be relatively routine and can be delivered today through the existing platforms. There is No Time to Waste as a Child with Wasting Today Cannot Wait Till Tomorrow!
Arjan de Wagt, Chief Nutrition
 Administrative approval of NNM – http://www.wcd.nic.in/sites/default/files/Administative%20Approval.pdf