Friday, 14 July 2017

Fighting Malnutrition with Community-Based Treatment

By Blandina Bait, Nutrition Officer

UNICEF is supporting the Government of Indonesia to implement the CMAM nutrition programme © UNICEF / 2017

Two-year-old Alfredo had been suffering from persistent diarrhoea for two days when his worried mother, Yosina, took him to the village health center, known as a puskesmas, near their rural farming community in East Nusa Tenggara Province, Indonesia.

The boy was very weak and looked pale; the health worker on duty confirmed that Alfredo had severe acute malnutrition (SAM).

“I was torn and shocked to learn that Alfredo was suffering from severe acute malnutrition,” said Yosina. She was even more alarmed to learn that SAM made Alfredo more vulnerable to diseases which could lead to death.

Yosina did not hesitate when the health worker advised her to enrol him in the Community-based Management of Acute Malnutrition (CMAM) programme for children aged 6-59 months. Though the cost of the one-hour round trip ($4) to the puskesmas for Alfredo’s weekly treatment would be a significant expenditure for the family of subsistence rice farmers, she and her husband agreed it was important for the sake of Alfredo’s future.

UNICEF is working in partnership with NGO Action Against Hunger, supporting the Ministry of Health to introduce the CMAM approach to treating severe acute malnutrition in Indonesia.

CMAM has a strong focus on community mobilization and active case-finding to ensure all children with SAM are identified and referred for treatment. It aims to eliminate distance as a barrier to access by treating children as outpatients in the community. Following WHO guidelines, only children with medical complications need be admitted as inpatients.

As outpatients, children receive Ready-to-Use Therapeutic Food (RUTF) and visit the health facility just once a week. This approach reduces the burden on both the health system and parents by allowing children without complications to remain at home during the treatment period. 
Before joining the CMAM programme, Alfredo had a poor appetite and was difficult to feed, often refusing to eat the rice porridge his mother gave him. But just three weeks into the CMAM programme, Yosina could already see positive changes in Alfredo; his appetite had improved and he had gained significant weight.
The results motivated Yosina to continue taking him to the puskesmas each week for follow up and after 8 weeks, he was cured and discharged from the programme.
As part of the programme, Yosina was also counselled on good Infant and Young Child Feeding practices as well as general health and nutrition advice to provide balanced meals for the whole family. She learned the importance of adding more vegetables and protein to their standard diet of porridge, rice or noodles to help fight malnutrition.
These days, Alfredo is a happy, active child with sharp, clear eyes. Smiling, he plays with his doll, while his mother chats to him fondly. He was the first child from Ekatata village to be enrolled in the program and the community is proud that he has been cured and discharged.

His mother is eager to share her experiences and motivate other parents in her village to regularly check their children’s nutritional status at the health centres and do monthly nutrition screening at the community health post.

Her relief is evident as she explains how the CMAM programme has transformed Alfredo’s health. “Now, I do not need to carry him around the compound just to finish a bowl of porridge because he has a good appetite; he always asks for food and finishes it.”