How effective is the integration of facility and community-based management of severe acute malnutrition in India?

Performance of nutrition rehabilitation centers: A case study from Chhattisgarh, India

Background:

High prevalence of malnutrition across India poses a significant obstacle to achieving desirable child health outcomes. For addressing childhood malnutrition, the government of Chhattisgarh during 2010–2014 established Nutrition Rehabilitation Centers (NRCs) in selected health units for the timely, adequate, and appropriate feeding of children, and for improving skills of mothers and caregivers on age-appropriate caring, counseling, and growth monitoring. This study examined the functioning of NRCs in three districts; assessed perception of mothers and carers of children admitted in the NRC; and assessed the perspectives of service providers.

Methods:

Four out of 46 NRCs were purposively chosen. Monthly performance reports of 2012–2014 were reviewed. Fifty mothers/carers of under-five children were interviewed; and ten in-depth interviews were conducted with the service providers. Descriptive statistics, co-relational, and regression models were used for data analysis; qualitative data were analyzed thematically.

Results:

Vacancy of staff ranged from 7.4% to 70%. The mean age of children during admission was 23.8 ± 6.2 months. The mean percentage weight gain was 11.6%, whereas the mean duration of stay in the NRC was 10.7 ± 3.5 days. Weight gain was directly related to the weight during admission. Follow-up visit and follow-up card issuing, counseling to mothers, special diet preparation, timely receipt of incentives, and training on diet preparation needed immediate attention.

Conclusions:

Regular review and supportive supervision could play a crucial role in improving the quality of services. The awareness level and expectation of mothers could be improved through NRC-based education and outreach services.

Does research through Structured Operational Research and Training (SORT IT) courses impact policy and practice?

SETTING

Structured Operational Research and Training Initiative (SORT IT) courses are well known for their output, with nearly 90% of participants completing the course and publishing in scientific journals.

OBJECTIVE

We assessed the impact of research papers on policy and practice that resulted from six SORT IT courses initiated between July 2012 and March 2013.

DESIGN

This was a cross-sectional study involving e-mail-based, self-administered questionnaires and telephone/skype/in-person responses from first and/or senior co-authors of course papers. A descriptive content analysis of the responses was performed and categorised into themes.

RESULTS

Of 72 participants, 63 (88%) completed the course. Course output included 81 submitted papers, of which 76 (94%) were published. Of the 81 papers assessed, 45 (55%) contributed to a change in policy and/or practice: 29 contributed to government policy/practice change (20 at national, 4 at subnational and 5 at hospital level), 11 to non-government organisational policy change and 5 to reinforcing existing policy. The changes ranged from modifications of monitoring and evaluation tools, to redrafting of national guidelines, to scaling up existing policies.

CONCLUSION

More than half of the SORT IT course papers contributed to a change in policy and/or practice. Future assessments should include more robust and independent verification of the reported change(s) with all stakeholders.

Promoting operational research through fellowships: a case study from the South-East Asia Union Office

In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) jointly developed a new paradigm for operational research (OR) capacity building and started a new process of appointing and supporting OR fellows in the field. This case study describes 1) the appointment of two OR fellows in The Union South-East Asia Office (USEA), New Delhi, India; 2) how this led to the development of an OR unit in that organisation; 3) achievements over the 5-year period from June 2009 to June 2014; and 4) challenges and lessons learnt. In June 2009, the first OR fellow in India was appointed on a full-time basis and the second was appointed in February 2012-both had limited previous experience in OR. From 2009 to 2014, annual research output and capacity building initiatives rose exponentially, and included 1) facilitation at 61 OR training courses/modules; 2) publication of 96 papers, several of which had a lasting impact on national policy and practice; 3) providing technical assistance in promoting OR; 4) building the capacity of medical college professionals in data management; 5) support to programme staff for disseminating their research findings; 6) reviewing 28 scientific papers for national or international peer-reviewed journals; and 7) developing 45 scientific abstracts for presentation at national and international conferences. The reasons for this success are highlighted along with ongoing challenges. This experience from India provides good evidence for promoting similar models elsewhere.