SAM -Severe Acute Malnutrition

Severe Acute Malnutrition (SAM)

Preventing Relapse in Children with Severe Acute Malnutrition (SAM)

This is a customized program in which trained nutrition counsellors in ARMMAN’s existing call centres handhold mothers of children with severe acute malnutrition (SAM) through direct calls on nutrition, hygiene, associated infections and stimulation.

There are a total of 20 direct calls sent weekly during 8 weeks of treatment and fortnightly for the next 6 months of rehabilitation. This program can be a stand-alone program or layered on top of mMitra, a free voice-call service by ARMMAN that provides weekly preventive care information during pregnancy and infancy to over 1.9 million women.

Rationale

7.5 % children under age 5 develop SAM in urban India. SAM reduces chances of survival [mortality rate:73-187 per 1000], hinders optimal physical growth and is associated with sub-optimal brain development leading to long-lasting negative impact on cognitive ability, school performance and future earnings. Poverty is a major underlying factor of malnutrition. In turn, malnutrition has an adverse impact on children’s cognitive development and reduces future earning potential leading to a vicious cycle. Lack of access to crucial lifesaving information for caregivers of children identified as SAM is a critical factor leading to relapse. In the current model of providing acute treatment for SAM children in Nutrition Rehabilitation Centers (NRCs), case-based counselling of care-givers is a challenge both during the treatment and rehabilitation phase as the child goes back to the same ill-informed environment where mothers lack accurate knowledge on care practises. Also, post-discharge from the NRCs, frequent follow-up visits are necessary. However, compliance is poor in marginalized communities due to lack of proximity of NRCs as their spread is thin.

Programme Design

Details of children identified as SAM through ICDS and NRCs will be accessed by ARMMAN. Trained nutrition counsellors in ARMMAN’s existing call centres will handhold mothers of children with SAM through direct calls on nutrition, hygiene, associated infections and stimulation. The direct calls are sent weekly during 8 weeks of treatment and fortnightly for the next 6 months of rehabilitation.

Salient Features

  • Regular counseling to mothers for ensuring adherence to treatment protocol and access to critical information on nutrition, hygiene, sanitation, infections and stimulation to prevent relapse.
  • Empowers mothers directly to take informed decisions, enabling rapid local action and prompt attention in an emergency.
  • Improved regular case-based monitoring and timely tracking of the child through trained nutrition counselors to complement existing service delivery through frontline health workers.

Scalability and Sustainability

The intervention is designed to be cost-effective as it leverages telecom and technology to reach out to women. It complements existing service delivery through NRCs and ICDS (Integrated Child Development Services) and can be made available to each SAM child availing treatment through the health system.

Impact

The intervention is currently being piloted as part of a Randomized Control Trial (RCT) with a sample size of 1000 children in Delhi and Mumbai, funded by Grand Challenges Canada with the support of the Government of Canada. It is 18-month study from March 2018 to September 2019.