Community Management of Acute Malnutrition Can Work in India

Sami Siva

Barcelona/New Delhi—The international humanitarian medical organization Doctors Without Borders/Médecins Sans Frontières (MSF) recently published evidence from its community-based management of acute malnutrition (CMAM) program in Bihar, which revealed that it has successfully achieved a cure rate of 88.4 percent among severely acute malnourished children who completed their treatment.

This conclusion was part of a study entitled "Community-Based Management of Severe Acute Malnutrition in India: New evidence from Bihar," which was published on April 1, 2015 in The American Journal of Clinical Nutrition, the world’s highest-ranked peer-reviewed medical journal in the field of nutrition.This observational analysis was conducted by MSF in collaboration with Darbhanga Medical College Hospital, and is based on results from the CMAM program that has been operational in Bihar’s Darbhanga district since 2009.

Treatment for severe acute malnutrition is a lengthy process, taking on average seven weeks. As such, outpatient treatment that allows the child to remain at home with only weekly visits to the treatment center (unless critically unwell) makes it much easier for caregivers to manage than lengthy stays in the hospital.The study details the results obtained between February 2009 and September 2011, during which time a total of 8,274 children aged 6 to 59 months old suffering from severe acute malnutrition (SAM) were admitted into the CMAM program.

“Of the total number of children, 87.3 percent belonged to socially and economically marginalized communities and households; 79.9 percent were between six months and two years old, and 62.2 percent were girls. These results suggest that severe malnutrition affects the most vulnerable groups in society,” said Dr. Prince Mathews, one of the authors of the publication.

The study also revealed that the majority (90.7 percent) of severely malnourished children did not suffer from other opportunistic diseases, and were therefore treated as outpatients in basic community health centers using an Indian-manufactured WHO-standard therapeutic paste. The minority of children with medical complications were treated as inpatients using therapeutic milk until they were fit to resume treatment in the community. Similar to existing hospital-based treatments, CMAM was hindered by a substantial default rate of 38 percent.

However, the conclusions of the study indicate that low mortality and high cure rates in severely malnourished children who complete their treatment can be achieved by implementing a community-based model of care. When children suffer from acute malnutrition, their immune systems are impaired and they are more susceptible to complications from common childhood diseases, such as a respiratory infection or diseases of the digestive system.

By identifying and treating them as soon as possible, a great majority of malnourished children are treated before medical complications develop in outpatient nutrition centers not too far from their homes. With an estimated 8.1 million SAM children under five years old (NFHS-3) in India, MSF calls upon authorities to implement and scale up community-based management initiatives within the public health system in order to save more lives and reduce the burden of acute malnutrition in India.

MSF in Darbhanga, Bihar

In close collaboration with the Bihar State Health Society, MSF continues to work with the medical staff in Darbhanga’s 11 primary health centers to ensure proximity and continuity of care to malnourished children. Since 2009, MSF has treated more than 17,000 severe acute malnourished patients aged between six months and five years. Its CMAM program remains the only community-based treatment program for severe acute malnutrition in India.

Learn more about the study and its findings here. 

MSF in India

MSF is an international, independent, medical humanitarian organization that delivers emergency aid to people affected by armed conflict, epidemics, exclusion from health care, and natural disasters. MSF has been working in India since 1999, and provides medical treatment to thousands of patients in Andhra Pradesh, Bihar, Chhattisgarh, Jammu and Kashmir, Maharashtra, Manipur, and Telangana. To support MSF or simply to obtain the latest information on MSF's medical humanitarian work in India and around the world, visit our website

MSF has been treating malnutrition in Bihar since 2009. In 2014 it started a malnutrition Intensive Care Unit in Sadar Hospital to help acutely malnourished patients with complications.
Sami Siva