07 Apr 15 08 Dec 16

India: Community management of acute malnutrition leads to high cure rates

Médecins Sans Frontières/Doctors Without Borders (MSF) recently published evidence from its community-based management of acute malnutrition (CMAM) programme in Bihar, India, which revealed that it has successfully achieved a cure rate of 88.4 percent among severely acute malnourished children who completed their treatment.

This conclusion was part of a study entitled, ‘Community-Based Management of Severe Acute Malnutrition in India: New evidence from Bihar, which was published on 1st April, 2015 in The American Journal of Clinical Nutrition, the world’s highest ranked peer-reviewed medical journal in the field of nutrition.

This observational analysis was conducted by MSF in collaboration with Darbhanga Medical College Hospital, and is based on results from the CMAM programme that has been operational in Bihar’s Darbhanga district since 2009.

A child's mid-upper arm circumference (MUAC) is measured to determine the severity of malnutrition in Bihar, India.

Treatment of severe acute malnutrition

Treatment for severe acute malnutrition is a lengthy process, taking on average seven weeks. As such, outpatient treatment that allows the child to remain at home with only weekly visits to the treatment centre (unless critically unwell), makes it much easier for caregivers to manage than lengthy stays in the hospital.

The study details the results obtained between February 2009 and September 2011, during which time a total of 8,274 children aged 6-59 months old suffering from severe acute malnutrition (SAM) were admitted into the CMAM programme.

“Of the total number of children, 87.3 percent belonged to socially and economically marginalised communities and households; 79.9 percent were between six months and two years old, and 62.2 percent were girls. 

"These results suggest that severe malnutrition affects the most vulnerable groups in society,” said Dr Prince Mathews, one of the authors of the publication.

The study also revealed that the majority (90.7 percent) of severely malnourished children did not suffer from other opportunistic diseases, and were therefore treated as outpatients in basic community health centres using an Indian manufactured, WHO-standard, therapeutic paste.

The minority of children with medical complications were treated as inpatients using therapeutic milk until they were fit to resume treatment in the community.


Benefits of community-based programmes

Similar to existing hospital-based treatments, CMAM was hindered by a substantial default rate of 38 percent. However, the conclusions of the study indicate that low mortality and high cure rates in severely malnourished children who complete their treatment can be achieved by implementing a community-based model of care.

When children suffer from acute malnutrition, their immune systems are impaired and they are more susceptible to complications from common childhood diseases, such as a respiratory infection or diseases of the digestive system.

By identifying and treating them as soon as possible, a great majority of malnourished children are treated before medical complications develop, in outpatient nutrition centres not too far from their homes.

With an estimated 8.1 million under-five-years-old SAM children (NFHS-3) in India, MSF calls upon authorities to implement and scale up community-based management initiatives within the public health system in order to save more lives and reduce the burden of acute malnutrition in India.


MSF in Darbhanga, Bihar

In close collaboration with the Bihar State Health Society, MSF continues to work with the medical staff in Darbhanga’s 11 primary health centres to ensure proximity and continuity of care to malnourished children.

Since 2009, MSF has treated more than 17,000 severe acute malnourished patients, aged between six months and five years. Its CMAM programme remains the only community-based treatment programme for severe acute malnutrition in India.

MSF in India

MSF is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, exclusion from healthcare and natural disasters.

MSF has been working in India since 1999, and provides medical treatment to thousands of patients in Andhra Pradesh, Bihar, Chhattisgarh, Jammu and Kashmir, Maharashtra, Manipur and Telangana.

To support MSF or to obtain the latest information on MSF's medical humanitarian work in India and around the world, visit our website www.MSFindia.in.

Learn more about this study and its findings

Find out more about MSF's work in India