'Policymakers and Industry Must Collaborate To Address Severe Malnutrition Issues'

There is an urgent need for consultations between policymakers and the Industry manufacturing therapeutic foods to bust the myths around Energy-dense Nutritional Supplement (EDNS) and meet the challenge of Severe Acute Malnutrition (SAM) squarely, said Deepti Gulati, India's well-known nutrition and public health specialist.

"EDNS has been scientifically proven to be the most vital component in the fight against SAM as evident from a number of pilot projects in the country," said Gulati while speaking at a webinar organised by Elets Technomedia that had speakers from Niti Aayog, Ministry of Ayush, leading corporates working in the field of child nutrition and CMAM Association of India as the knowledge partner.

Quoting her own experiences from the immensely successful Rajasthan Poshan Project, one of the largest Community-Based Management of Acute Malnutrition (CMAM) projects in the country, Gulati attributed the success of the project in a large measure to the EDNS provided by members of CMAM Association of India. The project was implemented by National Health Mission, Govt. of Rajasthan and supported by four key development sector organisations including Global Alliance for Improved Nutrition (GAIN), Unicef, ACF (Action Against Hunger) and Tata trusts.

Held in two phases, Rajasthan Poshan Project witnessed nearly 20000 children coming out of SAM successfully. The first phase held from Dec'15 to Jun'16 had enrolled 9640 children across 13 districts. The second phase had a much wider footprint across 20 districts and enrollment of 10900 children from Jan'18 to May'19. As many as 13% children recovered from SAM within 4 weeks while 88% children recovered between 8-12 weeks. Recovery rate was better than global standards.

According to Gulati, EDNS helped since it provided a concentrated source of energy and nutrition. An agency was hired for independent validation which showed that the majority of children recovered did not slip back.

"SAM is the most extreme and visible form of undernutrition and needs to be addressed on a war footing. The Case Fatality Rate (CFR) in children with SAM routinely crosses 20%. For perspective, the CFR in case of COVID is 1-2%," said Akshat Khandelwal, President CMAM Association of India.

Central CMAM guidelines which are awaited would go a long way in helping the state and district administration in their fight against SAM, he said. According to him, CMAM programme needs to get prominent place in the guidelines since there are only 1200 Nutrition Rehabilitation Centre (NRCs) in India which can cater to less than 5% of SAM children. Uncomplicated cases can be addressed through CMAM programmes as proved by several pilot runs.

Clearing the air on Ready-to-use Therapeutic Food (RUTF), Gulati stated that RUTF is not a replacement for Take Home Ration (THR). In fact THR is a food supplement while RUTF is therapeutic and for limited duration. In case of severely malnourished children, appetite is much less. The child can't consume much quantity but needs an increase in food intake. So the child needs a concentrated source of energy, proteins and micronutrients which are available in RUTF. Most of THR provide calories and proteins but do not provide all the micronutrients.

Earlier addressing the summit, Hemant Kumar Meena, Deputy Secretary (Women & Child Development), NITI Aayog, said, "Centre has launched Poshan Abhiyan to fight malnutrition in the country. We've partnered with UNICEF for Centres of excellence for SAM management activities."

Dr. Manoj Nesari, Adviser (Ayurveda), Ministry of AYUSH, highlighted how the Ministry had come up with a set of guidelines on Kuposhan Mukt Bharat based on Ayurveda. Discussions also saw deliberations from Khurram Naayaab, Head Operations, Project Nand Ghar, Vedanta Limited and Ravi Bhatnagar, Director External Affairs and Partnerships, Reckitt Benckiser.