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Ashish Satav

Ashish Satav

Dr. Ashish Rambhau Satav,. MAHAN Mahatma Gandhi Tribal Hospital

Title: Community-based management of severe malnutrition: SAM and SUW in the tribal area of Melghat, Maharashtra, India

Biography

Biography: Ashish Satav

Abstract

Objectives:

1. To achieve a recovery rate of 75% in severe acute malnutrition (SAM) children and 35% in severe underweight (SUW) children, in tribal community based management of severe malnutrition.

2. To achieve a case fatality rate of <4% in SAM and SUW children in the above setting.

3. To reduce current prevalence rate of SAM and SUW by at least 35% after 3 years of intervention.

Design

 Community-based prospective, single-group intervention study.

Setting:

 Primary and secondary care was given to participants from 14 villages of the tribal area of Melghat.

Participants:

 Severely malnourished children (SMC:734), tribal, male and female of the 6–60 months age group were enrolled and 680 children completed the study over a period of 3 years. Sample size (N = 762) was estimated -considering the prevalence of severe malnutrition (SAM and SUW) in 6–60 months population as 21.5%; design effect was 3.0 and relative precision was 10%, with 95% confidence interval.

Interventions:

 LTF (local-therapeutic-food) with MN (micronutrients), treatment of infections and BCC (behaviour change communication) were given for 90 days to SMC by VHW (village health worker).

Outcome measures

Rate of recovery, case fatality rate, and reduction in prevalence of SAM and SUW.

 

Results:

Majority of SMC (69.1%) in the 6–24 months age group were SAM, while majority of SMC (65.3%) in the 25–60 months age group were SUW. Recovery rate of SAM is 75.9%, 77.8%, and 79.4% at the end of 8th, 10th, and 12th week, respectively; the recovery rate for SUW is 37.5%, 42.7%, and 45.4%, respectively. Case fatality rate for SAM is 0.6% and for SUW is 0.2% after 8th week. There is significant reduction in prevalence of SAM (p – 0.005) and SUW (p – 0.0001) children at the end of the study.

Conclusions:

The study shows efficacy of LTF-MN and effectiveness of our community-based model in acute and chronic malnutrition. Further research is needed for deciding the exact duration of SUW therapy.

Trial registration:

 The study is registered under Protocol Registration and Results System (PRS) (ClinicalTrials.gov ID: NCT02671786).

Keywords:

SAM, SUW, LTF, MN, BCC