Purna Aahara -Community Management of Acute Malnutrition( CMAM) Programme

Malnutrition poses a significant global health threat, affecting children's cognitive and physical development and economic productivity. Malnutrtion contributes to nearly half of all deaths in children under 5, increasing susceptibility to infections and hindering recovery. Severe Acute Malnutrition (SAM) is particularly concerning due to its high mortality rates, defined by specific criteria such as low weight-for-height Z-score or bilateral pitting oedema.

In Odisha, the CMAM program, known as Purna Aahara, spearheaded by the Women and Child Development department, addresses SAM by providing comprehensive care at the community level. This initiative not only meets the immediate nutritional needs of SAM-affected children but also involves local women through Women Self-Help Groups (SHGs) in producting and distribution of Purna Aahara, empowering them to play an active role in combating malnutrition.

Purna Aahara Program:

The Purna Aahara (CMAM) program is a specially designed for management of children with Severe Acute Malnutrition at community level through locally  prepared Augmented Take Home Ration. 

It is a low-cost intervention with improved coverage by utilizing existing resources.

The objective of this Purna Aahara Program: -

• To manage / treat children with uncomplicated SAM at community level through use of standard protocols in close coordination with health department at all levels
• To build capacity of frontline health workers of ICDS and health for smooth implementation of Purna Aahara Programme through AWCs.

Principle of Purna Aahara:

Maximum Coverage and Access

Designed to achieve maximum by making service accessible to the highest possible proportion children in need irresoective of geographical and other barriers

Timeliness

Aims to identify and treat the children with Severe Acute Malnutrition early before develop medical complication

Appropriate medical and nutrition care

 

Simple and effective outpatient care for children with SAM who can be treated at home. Also give opportunity to identify the children with SAM that need clinical care (Inpatient) and provision of  requisite medicines and augmented Take home ration and counselling services.

Care for as long as needed

 

Aims to ensure effective treatment remain available for as long as the child needs. 

 

As per WHO guidelines, a SAM child requires 175-200 kcal / kg / day energy. This energy is derived from various sources such as 10-12% from protein (3-5g / kg / day), 25-30% from carbohydrate and 45-60% from fat / lipid. To fulfil this nutritional requirement, the existing Take Home Ration (THR) provided under Supplementary Nutrition Programme was augmented by adding additional vegetable oil and milk powder along with an additional egg. The composition of A-THR, recommended by National Institute Nutrition, Hyderabad, is provided below.

Indenting for A-THR is made to the identified SHGs by the District Social Welfare Officer (DSWO) as per the number of children enrolled under the CMAM (Purna Aahara) Program. DSWOs shares the indent for requisite medicine like multivitamins, Amoxicillin, Albendazole, Vit A, IFA etc. with the CDMO. In joint meetings held with the CDMO and officials of Health & FW Department, planning is done to ensure that the requisite medicines are available with the ANM at VHSND or CMAM clinic point.

 

 

Fixed day approach for mixing of ingredients and distribution of A-THR on the first day of every month is ensured at the districts.

Preparation and Supply of Augmented THR

• Augmented THR is prepared using roasted wheat, Bengal gram, groundnuts(as per the guidelines), sugar in the prescribed ration along with addition of vegetable oil and milk powder procured from the funds provided for augmented THR.OMFED Milk Powder and FSSAI approved sunflower / soybean / coconut / groundnut / rice bran / vegetable oil is used for preparation of A-THR.
• Quality checks of all the raw materials are done and details of A-THR prepared are recorded by the supervising officer.
• SHGs have procured blenders, sealing and packaging machinery for preparation of quality A-THR.
• Samples of ATHR are tested at the State Public Health Laboratory each month and quality of A-THR is thus maintained.
• To maintain quality and ease of usability, A-THR is packaged in 100 gm sachets with aluminum foil pack.