Community Based Management of Severe Malnutrition in Tribal Area of Melghat- Cluster Randomized Control Field Trial
Condition: Child Nutrition Disorders; Malnutrition
MeSH terms: Malnutrition; Nutrition Disorders; Child Nutrition Disorders
Study type: Interventional

Summary: 
      Provision of community based health care to severely malnourished children (Age group: 6
      months through 5 years) in 16 tribal villages by trained semi-literate village health
      workers.

        1. Treatment of severely malnourished children.

        2. Growth monitoring of all children below the age of 5 years.

        3. Treatment of associated diseases like Diarrhea, Pneumonia, Malaria, etc.

        4. Management of resistant or relapsed severely malnourished cases by pediatrician.

        5. Intensive behavior change communication of parents of children below the age of 5 years
           for proper nutrition.
    

Detailed description: 
      1. Title of project: SAMMAN- Community based management of severe malnutrition in under 5
      children in tribal area of Melghat region

      2. Name of Institution: MAHAN Trust, Address: Mahatma Gandhi Tribal Hospital, Karmagram .
      Utavali, tehsil- Dharni, Melghat (Amaravati)

      3. Objectives -

        1. To reduce the child mortality (in the age of group of 6 months to 5 years) due to severe
           malnutrition in tribal area of Melghat by 35% in usual residents population of 15000
           (from 16 villages) over a period of 3 years.

        2. To reduce the prevalence of severe malnutrition (in the age of group of 6 months to 5
           years) by at least 35% in usual residents population of 15000 from 16 villages in tribal
           area of Melghat over a period of 3 years.

        3. To achieve Case fatality rate of 2 % of treated severely malnourished children.

        4. Need and rational of the project :

           Melghat is a hilly difficult to approach tribal forest terrain in Amaravati district of
           Maharashtra, India . Population is 2,80,000 & 75% of them are tribal. Most of the tribal
           (>90 %) are farmers or laborers, living below poverty line(>75%) & very hard life in
           huts without electricity (>90%) & illiterate (>50%). Medical facilities are worst in
           Melghat as compared to rest of Maharashtra. A detailed study conducted by MAHAN showed
           that more than 20% of tribal children are severely malnourished and the under 5 children
           mortality rate is more than 100 per 1000 live births due to lack of proper nutrition,
           medical facilities, superstitions & reluctance for hospitalization of severely
           malnourished children. There is an immediate need to fight severe malnutrition in
           children between the ages of 6 months to 5 years. This project is being implemented as a
           pilot project in 16 villages of Melghat which has potential for replication in all
           tribal and rural part of India.

        5. Methodology Study design: The study is a cluster randomized parallel group controlled
           field trial Study area: 35 tribal villages selected from 5 clusters of Melghat by
           lottery method divided into intervention and control area.

           Sample size - 1500 severely malnourished children from intervention and control area
           each.

        6. Intervention:

      Provision of community based health care to severely malnourished children (Age group: 6
      months through 5 years) in 16 tribal villages by trained semi-literate village health
      workers.

        1. Treatment of severely malnourished children .

        2. Growth monitoring of all children below the age of 5 years.

        3. Treatment of associated diseases like Diarrhea, Pneumonia, Malaria, etc.

        4. Management of resistant or relapsed severely malnourished cases by pediatrician.

        5. Intensive behavior change communication of parents of children below the age of 5 years
           for proper nutrition.

           6. Duration: 5 years (May 2011 to September 2015)

           7. Monitoring indicators for the outcome objectives:

      Primary outcomes

        1. Prevalence of severe malnutrition (Severe Acute Malnutrition; Severe Underweight and
           Indian Academy of Pediatrician (IAP) Grade III, IV)

        2. No. of child deaths due to severe malnutrition

        3. Case fatality rate of treated severely malnourished children

           The secondary outcomes

        4. Child mortality rate between 6 to 60 months age group

           The secondary outcomes

        5. Child mortality rate between 6 to 60 months age group

      8. Scope & end result expected of project

        1. Lives of 1500 severely malnourished children from Melghat will be saved.

        2. This model of community based management of severe malnourished children using RUTF
           prepared by local tribal females from local produce will have better socio-cultural
           acceptance by parents, and will be palatable for children, hence will be more effective.

        3. It will also be useful in long term for preventing recurrences and roll back cases as
           parents awareness will be improved with behavior change communication.

        4. Based on this study, national and international policies related to community based
           management of severely malnourished children may be framed.

        5. It will be a step towards fulfillment of fundamental rights of children guaranteed by
           constitution of India.
    

Intervention name(s): MAHAN RUTF & MAHAN Vit-Min mix
Intervention type(s): Other
Intervention description(s): MAHAN RUTF dishes are locally prepared by local tribal women and each packet of RUTF provides 500-550 calories & 15-17 gms of proteins.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Severe Acute Malnutrition; Severe Underweight; IAP Grade III-IV; Severe Stunting; Village Health Workers; MAHAN RUTF & MAHAN Vit-Mim mix