Abstract:This paper demonstrates the effect of an innovative community-based management programme on acute malnutrition among children under three years of age, through an observationallongitudinalcohort study in tribal blocks in central-eastern India.

The key components of the programme include child care through crèches, community mobilisation and systems strengthening to ensure better child feeding and caring practices and delivery of public health and nutrition services.

For a cohort of 587 children, the increase in children in the non-wasting category is from 72% to 80% (p<0.001) and the reduction in Severe Acute Malnutrition (SAM) from 8% to 4% (p<0.005), a reduction of 46.6%. Normalcy is fairly well maintained at 89%. Among the severely wasted, 16% show no improvement, 49% moved into a moderate wasting category and 36% to normalcy over 4-6 months. Among the moderately wasted, 26% showed no improvement and 7% declined to a severely wasted category, and 67% moved to normalcy. The average Weight for Height Z-score (WHZ) for the cohort improved from -1.41 in the initial period to -1.13 in November (p<0.0001).

This study suggests that this medium term strategy using a rights-based participatory approach for community based management of malnutrition may be comparatively effective by current WHO guidelines and other known community based interventions in terms of mortality, cost, degree and pace of improvements.

Keywords: Malnutrition, wasting, SAM, crèche, community based management of malnutrition, acute malnutrition, underweight, CMAM, growth monitoring.

Abstract: Objective:The objective wasto reviewthe literature on school-based interventions during compulsory education (published in 2009-2013) that may be effective in increasing healthful nutritional outcomes in children. Specific strategies and their limitations will be identified.

Methods: A qualitative systematic analysis of seventeen school-based interventions applied to six-eleven year-old children, and published in peer-reviewed journals from 2009-2013 was carried out.

Results: These studies taken as a whole used a variety of fourteen strategies, such as provision of nutritional and gardening education; repeated exposure to vegetables (V); peer and adult modelling; chefs going into schools to teach healthy nutritional issues. These studies showed four types of limitations: limitations derived from the experimental designs and experimental procedures used and limitations affecting participant samples and data collection. Fifteen recommendations for overcoming the targeted research limitations were identified, such as applying the intervention during longer time intervals; examining the effectiveness of these interventions in different ethnicities and socioeconomic groups; including larger participant samples; using randomized designs. Finally, six new working hypotheses to guide future studies are proposed here. For example, a small number of V offered might lead to insufficient opportunities to learn to like the flavour of V; schools’ previous experience with these interventions might distort children’s post-intervention data related to their nutritional outcomes; providing children with nutritional and gardening education might increase their fruit (F) selection, consumption and preferences and application of evaluative conditioning under more appropriate experimental conditions might increase child V consumption.

Conclusion:seventeen school-based interventions were included. These studies taken as a whole used a variety of strategies (fourteen), and showed four types of limitations. Fifteen recommendations for overcoming the targeted research limitations as well as six new hypotheses are proposed here. Future research in this field should focus on overcoming its research limitations, such as the ones highlighted here, and building new working hypotheses, such as those proposed here.

Keywords: Children, vegetables, fruits, consumption, schools.