Community- and Facility-Based Interventions Reduce Child Malnutrition

{Photo credit: Mark Tuschman}Photo credit: Mark Tuschman

Malnutrition is an underlying cause of 45 percent of deaths in children under the age of five worldwide and leaves 165 million children stunted, compromising cognitive development and physical capabilities. Chronically malnourished children are, on average, nearly 20 percent less literate than those who have a nutritious diet. Thus, malnutrition can shape a society's long-term health, stability, and prosperity.

Management Sciences for Health (MSH) implements maternal, newborn, and child health projects that contain an important nutrition component. Projects are ongoing in the Democratic Republic of the Congo (DRC) and Madagascar, while two others, in Uganda and Afghanistan, were recently completed. All four projects were funded by the US Agency for International Development (USAID).

The 2013 Lancet Series on Maternal and Child Malnutrition identified 10 nutrition-specific interventions which could reduce child deaths by 900,000 per year in 34 high-burden countries – including the DRC, Madagascar, Afghanistan, and Uganda – and stunting by a fifth. MSH worked with its local partners in each of these four countries to scale up interventions, including those noted by The Lancet, to improve the nutritional status of mothers and children.

In the DRC, the Integrated Health Project (IHP) (2010 to 2015) works in four of the country's 11 provinces to create better conditions for and increase the availability and use of high-impact services, products, and practices. In the third year of the project, for example, more than 400,000 mothers received counseling during antenatal and postnatal care visits about early, exclusive, and continued breastfeeding and infant and young child feeding. Of 425,491 live births that year, 393,128 newborns, or 92 percent, nursed at their mother's breast within an hour after childbirth.

The project also supported nearly 500,000 pregnant women to receive iron and folic acid supplements during the two years ending in June 2014. Finally, IHP saved the lives of more than 900 children aged 1 to 59 months every year by providing Vitamin A supplementation during immunization or community outreach activities.

In Madagascar, the MIKOLO project (2013 to 2018) aims to increase the use of community-based primary health care services and the adoption of healthy behaviors among women of reproductive age, children under the age of five, and infants in nine of Madagascar's 22 regions. During the project's first year, while local capacity was being developed to implement community-based nutritional rehabilitation activities, 6,345 children screened as having severe malnutrition were referred to local health facilities or nutritional rehabilitation centers.

In Uganda, the STRIDES for Family Health project (2009 to 2015) worked with the Ministry of Health in 15 of the country's 111 districts to scale up nutrition interventions through its reproductive health, family planning, and child survival activities. Through its community and facility-based activities, STRIDES reached 614,338 children under the age of five through nutrition programs, achieving average cure rates for moderate malnutrition of 80 percent in some districts.

The project trained health providers in integrated management of acute malnutrition, provided nutrition information to school children, and promoted the World Health Organization's infant and young child feeding practices and essential nutrition actions for improving maternal, newborn, infant, and young child health and nutrition (PDF).

In Afghanistan, the Basic Support for Institutionalizing Child Survival (BASICS) project (2008 to 2011) worked to provide technical assistance in child survival with a focus on nutrition, community case management, basic essential newborn care, behavior change communication, integrated zinc supplementation, pediatric hospital care improvement, and health policy. As a result of the nutrition-related activities, the project achieved significant population-based impact. Eighty percent of children under the age of two who participated in community-based periodic nutrition counseling and growth monitoring sessions had gained weight between sessions.

Through its nutrition interventions, MSH and its partners are making a difference in countries where malnutrition and stunting threaten the progress that each of these developing nations is trying to achieve. Whether it's through providing nutrient supplementation, teaching mothers about the importance of breastfeeding, referring children for nutritional rehabilitation, training health care providers, or improving hospital care, MSH understands the vital need in communities and facilities to scale up nutrition interventions for lasting impact.