MSF’s anthropological study on rural Bihar’s health-seeking behaviour and perceptions of childhood undernutrition is selected as ‘Paper of the Month’ by Public Health Nutrition

New Delhi: Public Health Nutrition, a Cambridge University Press journal, has nominated MSF’s qualitative study entitled, ‘Health-seeking behaviour and community perceptions of childhood undernutrition and a community management of acute malnutrition (CMAM) programme in rural Bihar, India: a qualitative study,’ as the journal’s Paper of the Month. Published online, the study is based on narrative interviews of over one hundred and fifty family members of severely malnourished children.
Co-authored by Doris Burtscher and Sakib Burza, the study examines MSF’s six-year old community-based management of acute malnutrition (CMAM) programme in Darbhanga district of Bihar, India, looking at social, cultural and behavioural aspects of health-seekers.  Majority of the people who were interviewed said they did not perceive childhood undernutrition as a disease or a life-threatening condition. The limited understanding of the condition, the paper highlights, leads to poor health-seeking practices within the communities. Undernourished or malnourished children are denied medical treatment because their parents tend to seek traditional healers and local treatment instead of a doctor at a nearby, government-approved healthcare facility. The study also identifies social and cultural norms that influence and dictate the attitude of health-seekers toward treatment and care for malnutrition.
The study suggests that CMAM programs must make an effort to include communities and traditional healers to develop a holistic approach so as to ensure adequate medical treatment for malnourished children. The study can help provide guidance to community and nutritional health workers to find a middle ground and encourage communities to recognise undernutrition as a medical condition – one that can be treated within the existing primary health structure, using community-based resources.
MSF continues to work in Bihar to provide medical treatment to severely acute malnourished or SAM children and believes it is imperative to sensitize the communities towards the symptoms and debilitating effects of childhood malnutrition. In a country where there are 8 million SAM children, ensuring that communities seek timely and appropriate treatment for their undernourished children will go a long way in saving lives.
To learn more about the study and its findings, see:
MSF in Darbhanga, Bihar
Since 2009, MSF has, in close collaboration with the Bihar State Health Society, treated more than 17,000 SAM children aged between six months and five years. Its community-based management of acute malnutrition (CMAM) programme encompasses case detection by Accredited Social Health Activists (ASHAs) or community health workers at the community level, medical treatment for SAM children within the PHCs at the village level, a stabilisation centre/Nutritional Rehabilitation Unit (NRU) to treat SAM with minor complications at the block level, and a Malnutrition Intensive Care Unit (MICU) to treat complicated cases of SAM at the district level. The MICU was set up in March 2014 in collaboration with the Darbhanga Medical College and Hospital in March 2014 and has treated more than 300 complicated cases of SAM so far. To know more about the project in Bihar, please see: /country-region/fighting-malnutrition-bihar
MSF in India
MSF is an international, independent, medical humanitarian organisation that delivers emergency aid to people affected by armed conflict, epidemics, exclusion from healthcare and natural disasters. MSF has been working in India since 1999, and provides medical treatment to thousands of patients in Andhra Pradesh, Bihar, Chhattisgarh, Jammu and Kashmir, Maharashtra, Manipur and Telangana. To support MSF or simply to obtain the latest information on MSF’s medical humanitarian work in India and around the world, visit our website

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