Discussion
weight gain, gain, illness, malnutrition
MALNOURISHED, SEVERE MALNUTRITION, MALNUTRITION CHILDREN, MALNUTRITION
Using a cluster randomized trial this study demonstrated that, the impact of a home-based nutritious diet for malnutrition management proved effective to improve the nutritional status of malnourished preschool children. The intervention was unique as the trial focused on empowering mothers of malnourished underweight preschool children which provided an opportunity to combine behavior change in the form of knowledge improvement that promotes health, care practices during illness and adequate nutrition access to products that support the food-insecure households in providing a nutritionally adequate diet to their young children. The change in weight of the children in the intervention group was a steady improvement across different time points. There were significant weight gain and an increase in height among the children in the intervention group. A higher number of children attained normal nutritional status in the intervention group compared to the control group. There was a substantial improvement in the nutritional status of the children in the intervention group as against the control group.During the early 2000s, the World Health Organization (WHO) adopted the community-based management of acute malnutrition (CMAM) model and recommended ready-to-use therapeutic-food (RUTF) intervention to enhance the nutrition intake of children suffering from severe acute malnutrition (SAM) [Although WHO recommends the CMAM model its efficacy remains suboptimal due to various reasons in many countries. The acceptance of this recommendation has been limited in countries like India. The RUTF strategy for the management of malnutrition does not seem to be logistically feasible due to the complex interplay between poverty, social exclusion, and in-patient treatment with unacceptable costs to the family [Developing countries like India have a large number of malnourished children with a large proportion of them living in rural areas. Their parents lack proper resources, and high costs, which is unacceptable to the family. Delayed institutional management may lead to increased morbidity and mortality. Considering the current scenario, good dietary practice and convincing communication is the right way to correct the problems [The result of the study was broadly consistent with previous studies on the effect of interventions that promoted dietary practices and nutritional status of the children through behavioral change communication. A randomized controlled trial in Uttar Pradesh, India (2016) compared the WHO-recommended therapeutic food versus home-based food in the management of severe malnutrition. The mean rate of weight gain, gain in height, and increase in mid-upper arm circumference showed significantly higher (Many compared hospital management and home strategies for malnutrition children involving interventions in different combinations. Studies have found that a home-based diet is better than hospital management for malnutrition. Energy-dense therapeutic diets with low bulk are vital. It should be made economical, available, and acceptable. These home-based therapeutic diets could be prepared at home from the household pot. In a family, frequent feeding should be viable (6 to 8 times per 24 hours) and can maintain hygiene as well. Commercially accessible international RUTF may not be suitable (acceptable, cost-effective, and sustainable) for Indian settings with uncomplicated SAM [In our study, 20.5% of the study population achieved normal nutritional status from malnourished status in the intervention group, whereas in the control arm only 3.16% and also the proportion of severely underweight reduction was greater than the control arm. Larger number of malnourished children reached normal nutrition status and shifting from severe to mild malnutrition status was higher in the intervention group after 6 months of intervention [It is essential to comprehend that mothers/caregivers of malnourished children mostly come from low socioeconomic status and have difficulty leaving home for a long period during the treatment of malnutrition. If under-five children are identified in an early stage, home-based food therapy will be simpler, and cheaper with adequate quantity and quality of food resulting in a high success rate in reducing malnutrition, and low costs for the management of malnutrition. It also benefits the mothers spending their time with children and family. It also kindles or promotes the involvement of nutritious food preparation and interest in taking care of the child during sickness.It was strongly felt that, along with existing health and nutrition services such as ICDS, RCH II, IMNCI, and National Health Mission to the child with malnutrition, there is a need to educate and empower mothers. It should provide nutritional counseling to mothers of malnourished children. The health care provider should strengthen this counseling and endorse home-based food which is small, frequent, and energy-dense feeds. The content of the communication needs to be simple, appealing, technically correct, culturally acceptable, and practical. These messages need to be backed up by appropriate services.