Overview of Program Activities
| Activity | Description of Activity |
|---|---|
| Growth monitoring | SNEHA and ICDS frontline health workers jointly mobilized caregivers to bring children to the Anganwadi centers for monthly growth monitoring. The weight and height of all children in the community ages 0 to 6 years was measured. SNEHA frontline health workers used a mobile application to calculate weight-for-height nutrition grades and track information for children under age 3. Monthly growth monitoring enabled SNEHA frontline health workers to screen for severely and moderately wasted children and identify children at risk, including children faltering into malnutrition. |
| Home visits by SNEHA frontline health workers | SNEHA frontline health workers visited the homes of pregnant women and specific target groups of children under age 3 (severely wasted, moderately wasted, 0–6 months of age, and sick children). Caregivers, typically mothers, were counseled on various topics, including nutritious food habits and choices, age-appropriate nutrition, lactation and weaning, immunization, hygiene, and access to health services. SNEHA frontline health workers were trained on the topics of counseling and effective communication skills. Each target group had a specific protocol for the nature and frequency of visits, and program officers monitored the frequency and quality of the home visits. |
| Community-based medical nutrition therapy distribution | Medical nutrition therapy is a nutrient-dense dietary supplement for treating severely malnourished children. The peanut- and milk-based preparation was provided by the MCGM NRRC. Severely wasted or severely underweight and wasted children ages 7 to 36 months who have passed an appetite test and had no medical complications were eligible for medical nutrition therapy. Children were screened for complications by a pediatrician at a health camp or the NRRC before medical nutrition therapy treatment was initiated. Children were typically prescribed an 8-week treatment protocol with doorstep delivery of supplements and monitoring of consumption by SNEHA frontline health workers. |
| Health camps | Periodic health camps were organized by SNEHA in community spaces where a pediatrician checked wasted and sick children referred by SNEHA frontline health workers. Doctors validated the nutrition grade of the child, screened for complications, treated illnesses, prescribed medical nutrition therapy, and referred children for inpatient care. Other children also accessed the camps for minor ailments. |
| Referrals for MCGM and ICDS health services | Health posts are primary health facilities run by MCGM and responsible for numerous health prevention and promotion activities including distribution of iron-folic acid tablets and vitamin A syrup, deworming drives, immunizations, and detection and treatment of tuberculosis, leprosy, and malaria. SNEHA frontline health workers referred cases of illness and immunization to health posts and facilitated participation in deworming and vitamin A drives. The NRRC health facility is a center for inpatient and outpatient management of children with severe acute malnutrition; the NRRC validated the anthropometry conducted by SNEHA frontline health workers, conducted appetite tests and prescribed medical nutrition therapy, admitted and treated children with minor complications, and further referred children with severe complications to LTMGH, the tertiary MCGM hospital. SNEHA frontline health workers also referred children for services provided by ICDS including cooked meals and take-home rations. |
| Group meetings and community events | Health behavior change activities were conducted in the community, in partnership with MCGM and ICDS, through games, group discussions, celebrations, cooking demonstrations, and screening of educational movies. Events included breastfeeding initiation ceremonies, baby shower celebrations, and International Breastfeeding and Nutrition week. Every 6 months, mothers whose children recovered and remained recovered from severe wasting were celebrated in the community. |
Abbreviations: ICDS, Integrated Child Development Services; LTMGH, Lokmanya Tilak Municipal General Hospital; MCGM, Municipal Corporation of Greater Mumbai; NRRC, Nutrition Research and Rehabilitation Center; SNEHA, Society for Nutrition, Education and Health Action.