Participation of Village Health Nutrition and Sanitation Committees (VHNSC) on Social determinants of health (SDH) in a District in Maharashtra.

Background: Community participation is one of the core principles of Primary Health Care. VHNSC is example of community participation and is formed to take collective actions on health issues and its social determinants of health (SDH). It is envisaged as being central to local level community action to support decentralized health planning. Work on actual participation of VHSNC on SDH is almost negligible. Therefore, the present research study was conducted to find out the participation of VHNSC on SDH. Aim: To assess the involvement of VHNSC on SDH. Methods and Material: Knowledge on SDH and health actions of VHNSCs were studied using a questionnaire which was pretested and suitably modified. The study was conducted in all the 83 VHNSCs under 4 PHCs namely Waiphad, Anji, Kharangana Gode and Talegaon were choosen as per feasibility. Results: Members of all VHNSCs had knowledge about access to safe drinking water, sanitation and nutrition as SDH. Members from 6 (7.2%) VHNSCs could not relate literacy with health. Most had to be probed regarding knowledge about addiction to tobacco and alcohol; social deprivation and availability of emergency transport. Conclusions: VHNSC are moving in the right direction however they require continuous support, hand holding and monitoring from government and other NGOs.

Validating the MUAC (Mid-upper arm circumference) Cut-off for Detection of Severe Acute Malnutrition in Children Aged 6-59 Months in Rural Maharashtra

Objective: To review the Mid-upper arm circumference (MUAC) cut-off currently being usedto identify Severe Acute Malnutrition (SAM) as currently defined using Weight-for-Height.Methods: Cross-sectional study conducted in 24 villages of a Primary Health Centre inWardha district of Maharashtra among 2650 children between the ages of 6 to 59 months.Results: For identifying SAM, sensitivity of MUAC was 23.5% and specificity was 99.7% forcut-off <11.5 cm. Using Youden index, best Mid-upper arm circumference cut-off point toidentify SAM was <13 cm with sensitivity of 74.5% and specificity of 92.7%. Using Receiveroperating characteristics curve, best MUAC cut-off point was 12.8 cm with 74.5%sensitivity and 92.7% specificity. Area under curve was 0.88 (95%CI: 0.85-0.91).Conclusion:The current MUAC cut-off of <11.5 cm for detecting SAM needs to beincreased to ensure that children, who need referral for management of malnutrition, are notmissed.