CommCare for Community Management of Acute Malnutrition

A quarter of the world’s hungry live in India, and the prevalence of malnutrition in India is nearly double that of sub-Saharan Africa. Over 40% of Indian children are underweight, and in my father’s hometown in central India, that statistic jumps to 60%.

How does one begin to combat a public health problem on such a grand scale? CommCare could prove to be a vigorous start. Recently, our Dimagineers completed complex growth calculation charts that can be inserted into any CommCare nutrition monitoring application. The CommCare growth calculators use the WHO’s Child Growth Standards to determine anthropometric measures such as weight-for-height, weight-for-age, and height-for-age as well as MUAC-for-age. By using such calculators, Community Health Workers can quickly and easily determine with relative accuracy whether a child is severely or moderately malnourished by entering the relevant parameters such as weight and height.

I recently tested these calculators in one of our USAID funded CommCare Proof of Concept projects with the grassroots NGO Spandan Samaj Seva Samiti.  Spandan is based in my father’s hometown of Khandwa, Madhya Pradesh famous for its expansive railway junction and the home of India’s Charlie Chaplin figure Kishore Kumar. Khandwa is a predominantly rural town surrounded by adivasi or “tribal” villages. The vast majority of adivasi children in the region are severely or moderately malnourished, and suffer from both chronic and acute bouts of malnutrition. Spandan works with one such community called the Korku. Two years ago, I had the privilege of working with Spandan and researching malnutrition and food security among the Korku when I was postgraduate student at Oxford.

When I began working for Dimagi, I immediately saw the benefit of a tool like CommCare for monitoring and diagnosing malnutrition when I visited the Real Medicine Foundation (who coincidentally also work in Khandwa) as well as several other districts of Southwest Madhya Pradesh. Fortunately, I had the opportunity to return to Khandwa this year and deploy another nutrition application except this time with growth calculators.

The Spandan application follows the Community Management of Acute Malnutrition (CMAM) model and utilizes weight-for-age, weight-for-height and mid-upper-arm-circumference (MUAC) to triangulate malnutrition diagnoses for local children. Based upon the result of each measurement, the child may be referred to a local supplementary feeding program through India’s Integrated Child Development Scheme (ICDS) or to a Nutrition Rehabilitation Centre for severely malnourished children. The app reduces the need for Community Health Workers to look up information in complicated tables or plot the child’s information of cumbersome growth charts. By entering the weight, height and MUAC of the child, the application immediately informs the mobile user of the child’s nutritional diagnosis. This not only has the potential to save valuable time but can limit the level of human error when diagnosing children and referring them to the appropriate service. The application assures both the mobile user and the child’s caregiver of the child’s nutritional status and exactly where they should be referred to if need be.

Spandan is a true grassroots organization. Their staff come from the villages they serve. They speak the local Korku language and have even recorded counseling messages in the tribal language for the application. While training Spandan’s staff, I was presented with wider questions about the technology such as “What is an android?” and “How does data work?”

These questions caused me to launch into a larger explanation of what the Internet is, what search engines are, how to Google something and the differences between hardware and software. I asked the trainees if they had ever heard of “the internet”, “Google”, or a “smartphone”. These questions were met with resounding silence and I realized that though India is the considered a global IT hub, most of the population does not have access to modern technology. In a place that lacks basic sanitation, regular power supply not to mention limited access to enough nutritious food, the internet is far from people’s daily concerns. However, with the introduction of CommCare, regular internet access through the affordable Android phones given to Spadan’s staff has the potential to make a major dent in the unacceptably high rates of malnutrition in the region. By using the CommCare nutrition monitoring application, Community Health Workers have the ability to better diagnose malnutrition, make and follow up with clinical referrals and impart behavior change communication messages to local villagers.