Doctors Without Borders is lobbying for a change to the treatment of malnutrition in India, after Ko Awatea’s Luis Villa favourably evaluated a community based feeding programme.
Dr Villa, the research and evaluation manager for Ko Awatea, recently spent three weeks working in Bihar, north east India, evaluating a seven-year-old community based feeding programme.
Working for the French aid organisation Médecins Sans Frontières [Doctors Without Borders], the project was Ko Awatea’s first international evaluation contract.
Dr Villa explains that malnutrition in India was previously treated by the Nutritional Recovery Centres, but this approach reached less than 2 per cent of the country’s estimated 60 million malnourished children.
The World Health Organisation estimates that malnutrition contributes to 56 per cent of the mortality rate in under-fives, and one out of three malnourished children in the world lives in India.
The model Dr Villa assessed was a community based approach where 90 per cent of children are treated on an ambulatory basis, closer to their villages and avoiding long periods of hospitalisation.
This approach has previously produced positive results in Pakistan, Bangladesh, and regions of Africa. Under this approach, only complicated cases (roughly 10 per cent) are treated in specialised nutritional health facilities and 1 per cent of very complicated cases are dealt with at highly specialised secondary or tertiary level.
Nutrition and hunger are sensitive topics in India, linked to the historic fight for independence against Britain, Dr Villa explains. Any challenge to current practice around the treatment of malnutrition is controversial. Severe acute malnutrition, causing the highest mortality among malnourished children is not recognised as a clinical entity and therefore poorly diagnosed and treated by clinicians.
Implementing the community nutrition strategy was further challenged by a high rural population in Darbhanga (Bihar) low health literacy and the monsoon season of July to December restricting access to health services.
Dr Villa’s evaluation involved analysis of epidemiological and clinical data, and interviews with health workers, Indian officials and scholars as well as the parents and caretakers of the children being treated in the villages.
He says the project showed significant results in the reduction of mortality and morbidity among Indian children caused by malnutrition – down to around 1 per cent. The programme delivered a high cure rate, with more than 95 per cent of children discharged from the programme. These results are set to be acknowledged in a change to treatment guidelines which will now favour a community based approach, he says.
Médecins Sans Frontières has published these results in several international peer review journals.