Nutrition norms issued to tackle severe acute malnutrition

The National Technical Board on Nutrition (NTBN) has approved guidelines proposed by WCD Ministry for severe acute malnutrition.

The measures are part of the community-based health management of children suffering from SAM.

Severely malnourished children must be fed freshly cooked food prepared from locally available cereals, pulses, and vegetables. This is to be distributed by Anganwadi centers, as part of the country’s first-ever guidelines for nutritional management of children suffering from severe acute malnutrition (SAM).

The guidelines outline the role of Anganwadi workers and auxiliary nurse midwives (ANMs) in identifying severely wasted children. According to the recommendations, Anganwadi workers have to provide modified morning snacks, hot cooked meals and take home ration for SAM children.

They have to segregate those with edema or medical complications and sending them to the nearest health facility or nutrition rehabilitation centers. The remaining children are enrolled in “community-based management”. This includes the provision of nutrition, continuous monitoring of growth, administration of antibiotics and micro-nutrients as well as counseling sessions and imparting of nutrition and health education.

The morning snacks and hot-cooked meals, which are served at anganwadis to children between the age of three to six years, should be “prepared fresh and served at the centralized kitchen/ Anganwadi centers. Locally available cereals, pulses, green leafy vegetables and tubers, vitamin C rich fruits, as well as fresh milk and 3-4 eggs every week” have also been prescribed.

Importantly, the government has also revised the method to be used to measure wasting and advised calculating weight based on the height of children instead of the mid-upper arm circumference.

What necessitated this?

The government had, till now, only put in place guidelines for the hospitalization of severely wasted children who develop medical complications.

Severe acute malnutrition is the most extreme and visible form of undernutrition. Its face is a child – frail and skeletal – who requires urgent treatment to survive.

Children with severe acute malnutrition have very low weight for their height and severe muscle wasting. They may also have nutritional edema – characterized by swollen feet, face, and limbs. About two-thirds of these children live in Asia and almost one third live in Africa.

Severe acute malnutrition is a major cause of death in children under 5, and its prevention and treatment are critical to child survival and development.

Across the globe, an estimated 16 million children under the age of 5 are affected by severe acute malnutrition. This number is staggering – most importantly, because children with severe acute malnutrition are nine times more likely to die than well-nourished children. These deaths are the direct result of malnutrition itself, as well as the indirect result of childhood illnesses like diarrhea and pneumonia that malnourished children are too weak to survive.

Severe acute malnutrition can increase dramatically in emergencies. But despite what we see in the headlines, the majority of cases occur in developing countries not affected by emergencies. These settings are plagued by chronic poverty, lack of education, poor hygiene, limited access to food and poor diets. The result is significant barriers to sustainable development in these nations.

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