India’s leading nutrition panel, the National Technical Board on Nutrition (NTBN), has rolled out a fresh batch of instructions aimed at addressing severe acute malnutrition (SAM) in children. For the first time, they’ve set detailed nutritional guidelines for severely malnourished children.
The NTBN proposes that anganwadi centres provide children with freshly cooked food made from local cereals, pulses, and vegetables. These are unprecedented guidelines for managing children grappling with SAM, marking a new approach to community-based child health management.
SAM is characterised by a critically low weight-for-height ratio, noticeable severe wasting or nutritional oedema. Reducing malnutrition is pivotal for decreasing child mortality and enhancing maternal health, as it indirectly or directly contributes to a staggering 35% of deaths among under-five children.
What is the National Technical Board on Nutrition?
The NTBN was established in 2017 under the Ministry of Women & Child Development to provide technical advice on vital nutrition policy issues. The board convenes once every three months and offers advisory recommendations.
Before these new guidelines, the government had only outlined protocols for hospitalising severely wasted children who developed medical complications in 2011, without providing any nutritional guidance.
The New Guidelines: A Strategy to Address Severe Acute Malnutrition
Under the revolutionary guidelines, anganwadi centres are directed to freshly prepare morning snacks and hot meals for children aged three to six. The meals should incorporate locally available cereals, pulses, green leafy vegetables, tubers, vitamin C-rich fruits, fresh milk, and 3-4 eggs weekly.
Severely wasted children will be identified by anganwadi workers and auxiliary nurse midwives (ANMs). Those suffering from oedema or other medical complications will be directed to the nearest health facility or nutrition rehabilitation centers.
The remaining children, those not faced with medical complications, will be registered into the “community-based management” program. This initiative includes offering nutrition, consistent growth monitoring, antibiotic and micronutrient administration, as well as educational sessions on health and nutrition.
Oedema and its Link to Malnutrition
Oedema is a condition marked by fluid accumulation in the body, causing swollen tissues. Although it regularly accompanies prolonged periods of sitting or standing, it also manifests as an adverse effect of malnutrition. Oedema often resolves independently but can be indicative of severe underlying malnutrition, especially in children.
In addition to these new guidelines, the government also recently updated the method for measuring wasting. Now, children’s weight is determined by their height rather than their mid-upper arm circumference. The implementation of these changes marks a significant step in India’s fight against child malnutrition.