Studying the effectiveness of mixed models of community based and institutional based interventions for management of severe acute malnourished children

Background: Children with severe acute malnutrition (SAM) have nine times higher risk of dying than well- nourished children. Child malnutrition can be managed by community based approach (80-85% SAM children) and institution based approach (10-15% SAM children). The objective of the study is to know the effectiveness of the mixed interventions to improve the nutritional status of the children (0-6 yrs), to decrease the prevalence of malnutrition in the children attending ICDS in Rajkot city for combating child malnutrition. Methods: A baseline survey of total registered 26578 children was carried out at 330 anganwadis and 701 SAM children were identified till the end of June 2014. A model of mixed interventions i.e. i) Community based management consisting of special food program, monthly health checkup and treatment and health education to parents, ii) Institution based management of SAM children with complication was planned and implemented since July 2014.Results: 701 children were identified as SAM at the beginning of the intervention while 160 children were SAM at the end of March 2015. The difference in the proportion of SAM children before and after intervention was statistically significant. An improvement of 80.9% in the status of SAM children was seen among boys while 74.1% was seen among girls.Conclusion: Convergence of Health and ICDS activities, high risk approach, community based and institutional management and community awareness in combating the malnutrition showed significant effect. This model can be replicated elsewhere and sustainability may be ensured for long term results.