Prime Minister's Overarching Scheme for Holistic Nutrition (POSHAN) on Wheels as a Drive Towards Combating Malnutrition Among Children in Coastal Gujarat.

ABSTRACT

Background Gujarat, India, is home to severe acute malnutrition. Wasting in children is associated with a higher risk of death if not treated properly. The present study identified children under five years of age with severe acute malnutrition (SAM). It provided energy-dense nutrition supplement (EDNS) during the rising cases of COVID-19 to treat them as per the guidelines of the government of Gujarat in Devbhumi Dwarka District of Gujarat State, India.  Methods A descriptive research design was used in the study. Children were screened by a Nutrition Assistant in the presence of an Anganwadi Worker (AWW), Auxiliary Nurse Midwife (ANM)/Community Health Officer (CHO) at Anganwadi Centre or the Child's home using weight/length Z score <-3 standard deviations (SDs) or mid-upper arm circumference (MUAC) <11.5 and identified severe acute malnourished children were provided EDNS (WHO composition) for a period of seven days initially for a starting period as per the child's body weight then followed up to eight weeks. Data was entered on the spot in a Google sheet, which nutrition assistants maintained. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States) and Microsoft Excel 2019. Results The study revealed that 23% of children were considered in the SAM category, followed by 21% in the Bhanvad block and 24% in the Dwarka block. For the Bhanvad block, 40% of the children were treated normally with a maximum weight gain of 1 to 2 kgs (63%). Similarly, for the Dwarka block, 29% of children were treated normally with a weight gain of 1 to 2 kgs (64%). Conclusions The study identified children with SAM and provided EDNS for eight weeks. To strengthen the program, the engagement of frontline functionaries of government should be increased, which plays an active role in the community and can be a bridge to the community. As in the community-based management of acute malnutrition (CMAM) program, Accredited Social Health Activists (ASHAs) are responsible for reaching out the ready-to-use therapeutic food (RUTF) to the mothers, weighing of children is done jointly by AWWs and ASHAs on a weekly basis, as well as counselling of the mothers on care and feeding practices and hygiene, and therefore every ASHA receives an incentive of Rs. 25 per child per week to monitor the progress of the child, reach out the therapeutic food, and counsel the mother. This system should be linked with Prime Minister's Overarching Scheme for Holistic Nutrition (POSHAN) on wheels program.