Challenges for Community Based Management of Uncomplicated Severe Acute Malnutrition: A Case Study in a Village of District Panchkula, Haryana

Severe acute malnutrition (SAM) is one of the preventable causes of mortality and morbidity in Under 5 children. As per NFHS 4 report, 7.5% of the under 5 children are severely wasted, 38.4 % are stunted and 35.7% are underweight. Despite being a focus in MDGs and now in SDGs, there is no significant decline in these indicators. We present a case study of SAM child in rural area and how the challenges were overcome. Case selection: A 4 year old male diagnosed as SAM in Anganwadi was selected. Methods: 1) Clinical assessment: As per clinical examination child had uncomplicated SAM as per WHO Criteria   2) Dietary assessment: There was deficit of 600 kcal of energy and 6 gms of protein. 3) Psychosocial Assessment: Mother thought that it is due to some “Jaadu” “Opri Hawa” and had taken some black thread from a faith healer. AWW believed that such families do not cooperate and such poor people cannot be treated. Intervention: Home based recipes from Ministry of Human Resource Development were introduced. This included milk based recipes, halwa and khichidi etc. Family was motivated and support environment was created by involving local health worker , Anganwadi worker and ASHA. Measurements: Daily food intake and weekly weight monitoring was done. Subjective impressions of the family as well as health worker/ Anganwad workers and ASHA were documented. Results:   1) The child gained 800 gms of weight in 5 weeks and moved from severe malnutrition grade to moderate malnutrition grade. 2) The family behavior changed from resistant to co operative mode after looking at positive progress in child. 3) Anganwadi workers started giving special diet recommended for Severe Acute Malnourished children. However, still she is not able to believe that malnutrition can be treated among this poor segment Conclusion: Pathway of success in management of SAM lies in persistent practice of Public Health Approach.