Counsellor Program for Saving Severely Malnourished Children by Improvement of Government Hospitals of Melghat : Result of a Field Trial

Abstract

Background: Melghat is tribal area in India (population of 280 thousands )with high children mortality(U5MR>100/1000 live births ), malnutrition (>75%) and maternal mortality (>400 per 100000 population) due to poor hospitalisation. Due to bad government hospitals, hospitalisation of severely malnourished children (SAM) (< 1%) & hospital deliveries( < 5%) were very low. We developed counsellor program to improve hospitals & reduce children mortality and malnutrition. Aims: Methods: It was RCT. Intervention area were 14 government hospitals of Melghat ( Amaravati, India). Control area were hospitals of Nadurbar and Gadchiroli. Study period : 2007-08 to 2009-10 .22 counsellors did counselling, BCC, motivation of patients, strengthening of hospitals, etc. Results: Study resulted in proportional improvement among hospitalized malnourished children { (95% CI)} by 96% (90.6 - 100)(Melghat), 53.8% (26.7 - 80.9)( Gadchiroli) & 34% (21.2 - 46.7) (Nandurbar). It improved hospital deliveries & hospitalisation of SAM children by 212% & 1567% (Melghat), 72% & -70% (Gadchiroli) & 112% & -69.54% (Nandurbar) respectively in 2009-10 over baseline & Melghat Government hospitals. Conclusions: Counsellor program resulted in statistically highly significant improvement in nutritional status of hospitalised SAM children of Melghat (p-value: 0.0001), increased hospital deliveries & hospitalisations of SAM children and reduced child and maternal deaths of Melghat. Changed health policies.