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CHPE Bhopal – Nutrition Report

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CHPE Bhopal – Nutrition Report REPORT ON THE PROJECT “REDUCING CHILDHOOD MALNUTRITION THROUGH COMMUNITY EMPOWERMENT IN MADHYA PRADESH”. SUBMITTED TO ASSOCIATION FOR INDIA’S DEVELOPMENT by SOCHARA Bhopal office July 2018 1 INTRODUCTION The project “Reducing Childhood Malnutrition through Community Empowerment in Madhya Pradesh” has been supported by the Boston and Columbus Chapters of the Association for India’s Development (AID), since August 2016 and August 2017, respectively. The long-term goal of the project is to bring about an improvement in the nutritional status of children, particularly in the under-five years age group. The short-term objectives include raising awareness on the underlying causes of malnutrition; educating communities on aspects of malnutrition and the relation of sanitation and infections to malnutrition; enhancing the involvement of the community in the functioning of the anganwadi and other activities of the ICDS programme. The strategies employed include providing intensive health education to the community directly and with the help of existing groups within the community (youth groups, mahila mandals). Capacity building of the partner organisations (NGOs) is an important aspect, which enables them in turn to educate and empower the community. This is in the form of intensive training on nutrition, malnutrition, child care and related areas of sanitation and immunization. Engagement with the Govt. Departments of Health and Women & Children’s Development is also envisaged, to give appropriate feedback from the field, as well as ensure co-operation and support from the ASHA worker and ANM. A number of activities have been carried out in the course of the last year as a part of the project, in the areas of Bhopal city and Ganj Basoda block in Vidisha district. These include training of staff and workers in basic and applied aspects of nutrition, regular visits to provide field support, growth monitoring and analysis of the data received, feedback to the NGO staff and through it to the community. SOCHARA has also been approached by other organisations involved in child nutrition, to provide technical inputs and training to staff and field workers. The analysis of the growth monitoring data generated in the field has been done regularly. With appropriate software, the data has also been statistically analysed, to determine if there is a significant difference in the levels of malnutrition in the children over a period of time. This report describes the work done as a part of the project. AREAS OF WORK 1. Slums of Bhopal city – currently SOCHARA works in two slums on the outskirts of Bhopal city, namely Baghmugaliya (on the south-east corner of Bhopal) and Gandhinagar (on the north-west of Bhopal, near the airport). These are areas where our partner organisation Muskaan also works. 2. Vidisha district – SOCHARA works in collaboration with Prasoon in Ganj Basoda block of Vidisha district of Madhya Pradesh, approximately 100 km north-east of Bhopal city. 3. New field areas – we are constantly exploring the possibility of expanding our work into new field areas in other districts of Madhya Pradesh state, as well as in Bhopal city. We have conducted training sessions in nutrition for 2 organisations working in these areas, as a preliminary step before working with them. REVIEW OF ACTIVITIES A. Training This is an important part of SOCHARA’s work with its associated and partner NGOs. As there is much ignorance, lack of knowledge and skills in areas of nutrition, malnutrition and related aspects of child care and child health, training of staff at different levels (field staff and community level workers) is an essential part of nutrition work in the state. Some of the areas covered by training are as follows: o Nutrition – basic principles and applied aspects. o Malnutrition in children = detection, main features, management at community level, prevention, other related problems (eg. anaemia and vitamin deficiencies). o Child nutrition – breastfeeding, complementary foods (weaning), feeding of older children, growth monitoring. o Child health – common diseases of children (eg. diarrhoea and pneumonia) o Immunization. o Sanitation and its relation to health. Training sessions have been conducted for the following: 1. Prasoon which works in Vidisha district. Their field staff and community level workers have received training on most of the topics mentioned above. 2. Vikas Samvad – a networking organisation with members in the districts of Panna, Rewa, Umaria and Satna. The training covered the basic and applied aspects of nutrition. The member NGOs work with about 100 anganwadis in these districts, and have expressed a need for additional inputs from SOCHARA. 3. CFI Bhopal – an organisation working in 6 slums of Bhopal. B. Field support Along with regular training of field staff and community level workers, regular field visits are made to follow up the training. During these visits, the field staff are assessed for their ability to use skills and knowledge acquired during their training in the course of their work. Some examples of this are: * Giving the correct health education to mothers and other family members * Correct techniques in growth monitoring and interpretation of results. * Interaction with Government workers (ASHA and Anganwadi workers) 3 C. Growth monitoring The weights of children under five years are taken at regular intervals (usually monthly) and analysed to determine the number of normal, moderately and severely malnourished children. This activity is done in collaboration with the anganwadi staff as far as possible. While we are analysing the data received by routine methods (using Excel spreadsheets and calculating the proportion of normal, moderately and severely malnourished children), we are also using appropriate software. This software (Anthro, developed by the World Health Organisation) enables longitudinal assessment of children individually, as well as cross-sectional assessment of children in a community as a whole. The latter is useful for comparisons with different communities at a particular point of time, as well as longitudinal assessment of a particular community when done repeatedly over a period of time. Feedback The results of the analysis of the growth monitoring data is communicated back to the partner organisations, their field and community level staff, and ultimately to the community for appropriate action. This feedback is in the form of information about the number and names of children with moderate and severe malnutrition, in the field area as a whole and in individual villages. RESULTS The growth monitoring related activities have been conducted regularly in the field areas. This has provided a large quantity of data regarding the nutritional status of children in the slums of Bhopal city, as well as the villages of Ganj Basoda block of Vidisha district. In Bhopal city, the field areas had to be changed due to extensive demolition, re- development and re-settlement of people in the slums in our original field areas. Consequently, a comparison between the situation in February 2017 and July 2018 cannot be made, as the areas are different. However, in the villages of Ganj Basoda block of Vidisha district (the field area of Prasoon), we are able to compare the effects of our interventions in the same period of time. The results of growth monitoring are below: Name No. of Anganwadis No of Children Children Children of areas / Balwadis children weighed with malnourished District covered registered normal (no.) weight Bhopal (urban) January 2 4 410 395 257 138 2017 Slums (65.0 %) (34.9 %) 4 July 2 4 378 354 222 132 2018 Slums (62.7 %) (37.2 %) (new areas) Vidisha (rural) February 25 20 871 683 343 340 2017 Villages (78.4%) (50.1%) (49.8 %) July 25 38 2296 1531 919 612 2018 Villages (66.7) (60.0%) (40 %) The growth monitoring data of the villages of Vidisha district has been analysed using WHO Anthro, a statistical software developed by the World Health Organisation for this purpose. As mentioned above, the software enables longitudinal assessment of individual children over a period of time. It also enables a cross-sectional assessment of a group of children at a particular point of time. We have analysed the data at two points of time (February 2017 and July 2018), and the results are presented in the graphs below (figures 1 and 2). Only children with complete data (date of birth, weight, name, father’s / mother’s name) are included in the statistical analysis. As can be seen from the table above, there has been a significant increase (tripling) of the number of children weighed this year as compared to last year. The lower percentage of children weighed of those enumerated is a result of increased migration at this time of year, compared to the beginning of the year. Figure 1 Weight for age distribution of children in Vidisha in February 2017 5 Figure 2 Weight for age distribution of children in Vidisha in July 2018 While comparing the two graphs, there is a small but definite shift to the right (ie. towards normal) in the second graph of July 2018. Data analysis shows that there has been a ten percent reduction in proportion of children malnourished between 2017 and 2018 in these 25 villages. We did not find a significant change in the proportion of severely malnourished children (16% to 13.4%) however. We attribute the overall reduction in malnutrition to the improved health education activities carried out by the staff there. Activities aimed at specifically addressing severe acute malnutrition have not been taken up as yet. CONSTRAINTS a. Partner organisations / NGOs – our associated NGOs have had problems with funding, particularly long gaps between funding cycles, sometimes extending to a year. During these times, essential nutrition-related activities have been curtailed or stopped, due to a lack of staff and finances for salaries and travel. However, now funding is assured for the next two to three years.
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