Menu ENN Search

Wasting in South Asia: Consultation on building the evidence base on the policy and programme response

A one-day consultation was held in New York on 16 November 2018 to examine the evidence on wasting in South Asia and guide the direction of future collaborative efforts of the No Wasted Lives coalition in the region. The consultation was organised by UNICEF with the following objectives: (1) to share the status of policy and programme action to care for severely wasted children in South Asia; and (2) to identify evidence gaps, research priorities and way forward to build the evidence base to inform the policy and programme response in South Asia. Members of No Wasted Lives and the Council of Research and Technical Advice on Acute Malnutrition (CORTASAM) and researchers and academics were invited to join the consultation. There were 32 participants, including 13 participants who joined the meeting remotely.  

In the morning, presentations examined the context of and response to wasting in South Asia, with a specific focus on India, which carries about 80% of the regional wasting burden and where the government is developing national guidelines on the community-based management of acute malnutrition (CMAM). In the afternoon, the participants discussed the implications of the data and evidence presented on the design of policies and programme to prevent and manage severe wasting. The following conclusions were drawn.

First, the South Asia context has several unique characteristics that require further exploration because they may warrant alternative approaches to the care of wasted children. The ‘very high’ prevalence of wasting (15.9%) in South Asia exceeds all other regions, yet the post-neonatal mortality rate is relatively low. Contrary to countries in other regions, the prevalence of wasting is highest at birth in South Asia, which suggests that poor maternal nutrition is a key driver. A higher proportion of wasted children in South Asia experience wasting for prolonged periods than in sub-Saharan Africa. In India, severely wasted children respond lower and slower to treatment for reasons that are not fully understood. There are also questions concerning the mortality risks of severe wasting and child survival benefits of treatment in South Asian countries, which appear to be lower than in sub-Saharan African countries. Nevertheless, the mortality risks are not low enough to ignore, particularly in the first six months of life, and there are potentially long-term impacts of wasting on cognition and learning. 

Second, the draft of India’s national CMAM guidelines and the country level adaptations build on the relatively strong community platforms for early case detection, community-based management and referral in India. With these guidelines, the government seeks sustainable solutions that focus on both the prevention and treatment of wasting, including during the first six months of life. The current draft of the guidelines supports the use of weight-for-height (but not mid-upper arm circumference) to identify wasted children and does not promote the use of ready to use therapeutic food to treat severely wasted children, even though these are supported by the World Health Organization (WHO) recommendations. These approaches are likely to be adequate, provided the intervention provides a quality product that complies with WHO specifications, and systems are in place to identify and refer severely wasted children with medical complications for inpatient care. These guidelines provide an opportunity for a learning agenda including the cost-effectiveness of this alternative model of care for severely wasted children.

Third, research in South Asia can contribute to global and regional efforts in optimising and innovating care and treatment approaches for children with severe wasting. Areas of research include identifying effective approaches to prevent and manage wasting in infants aged less than six months; modifications in the quantity, duration and formulations of ready-to-use therapeutic food (RUTF) use in nutritional rehabilitation; the use of home-based foods or home-augmented foods to treat severe wasting; and transitioning from treatment foods to family diets. This research could facilitate the development of a greater range of treatment options that are tailored to cultural preferences and have the potential for greater coverage, quality and sustainability of care and treatment for severe wasting. 

In moving forward, the participants identified the need for a new narrative on wasting in South Asia (and globally) that considers prolonged versus short episodes of severe wasting; that links wasting with stunting; and that frames the functional consequences of wasting on cognition and learning as well as the mortality risks. CORTASAM offered its expertise by supporting further exploration on wasting in South Asia through a sub-working group of the CORTASAM. Potential areas of focus for this working group include: further context-specific refinement and expansion of priority evidence gaps in South Asia that complement the CORTASAM research agenda; the design and/or review of protocols for secondary data analysis and implementation research; and the interpretation and dissemination of research findings.

For further information please contact Harriet Torlesse.

More like this

Blog post: Stunting & Wasting in South Asia- Reflections from a Regional conference

Lire ce blog en francais Over the years the scope of ENN's work has expanded beyond a focus on humanitarian contexts to encompass a broader set of issues around drivers of...

FEX: Higher heights: a greater ambition for maternal and child nutrition in South Asia

Research Summary 1 Poor nutrition in early life threatens the growth and development of children, which has a knock-on effect on the sustainable development of nations. This...

FEX: Driving evidence to action: The Council of Research & Technical Advice on SAM (CORTASAM)

Amy Mayberry is Head of Evidence at Action Against Hunger, where she supports the technical and research activities of No Wasted Lives, including CORTASAM. She previously...

FEX: Report on innovations in CMAM

By Anne Marie Kueter, Claudine Prudhon, Emily Keane and Megan Gayford The implementation of community-based management of acute malnutrition (CMAM) as the standard model of...

FEX: Prioritising acute malnutrition research: preliminary results of a CHNRI survey

By Amy Mayberry and CORTASAM members Amy Mayberry is Head of Evidence at Action Against Hunger, where she supports the technical and research activities of No Wasted Lives,...

FEX: No Wasted Lives: Accelerating action for children with acute malnutrition

By Saul Guerrero, Nancy Aburto, Erin Body, Diane Holland, Guy Holloway, Abigail Perry and Sophie Whitney Saul Guerrero is the Director of International Nutrition Initiatives...

FEX: OptiMA study in Burkina Faso: Emerging findings and additional insights

By Kevin PQ Phelan Kevin PQ Phelan is Nutrition Advisor at ALIMA, the Alliance for International Medical Action based in Paris. Before joining ALIMA he worked for...

FEX: OptiMA study in Burkina Faso: Emerging findings and additional insights

By Kevin PQ Phelan Kevin PQ Phelan is Nutrition Advisor at ALIMA, the Alliance for International Medical Action based in Paris. Before joining ALIMA he worked for...

FEX: Severe acute malnutrition: an unfinished agenda in East Asia and the Pacific

By Cecilia De Bustos, Cécile Basquin and Christiane Rudert Lisez cet article en français ici Cecilia De Bustos is a nutrition and public health specialist who...

FEX: Community-based Approaches to Managing Severe Malnutrition

One nutrition worker's solution to childcare at a busy feeding distribution! A three day meeting was held in Dublin hosted by Concern and Valid International between 8-10th of...

FEX: CMAM in Cambodia – indicators of acute malnutrition for screening

By Jennifer Carter and Joel Conkle Jennifer Carter is a second year MPH student at the Tulane University School of Public Health and Tropical Medicine in the Department of...

FEX: Making connections: Joint meeting of WaSt Technical Interest Group and MAMI Special Interest Group

ENN coordinates two international technical groups, the Management of at-risk Mothers and Infants under six months Special Interest Group (MAMI SIG) and the Wasting and...

Blog post: Setting Research Priorities to Guide Action for Acute Malnutrition

Lire ce blog en francais I hope some of you have heard of No Wasted Lives. For those who haven't, now is the time to join forces with this coalition of partners working to...

Management of At Risk Mothers and Infants (MAMI)

Donors: Irish Aid Collaborators: LSHTM, University of Washington, KEMRI-Wellcome Trust Project and CHAIN (Kenya), WHO, UNHCR, UNICEF, Save the Children, ACF, Goal, MSF, World...

FEX: Managing severe acute malnutrition in India: prospects and Challenges

By Biraj Patnaik Biraj Patnaik is the Principal Adviser to the Commissioners of the Supreme Court of India in the right to food case. He is also associated with the Right to...

FEX: Review of scale and drivers of persistent global acute malnutrition

Summary of research1 Location: Global What we know: The prevalence of global acute malnutrition (GAM) regularly exceeds the emergency threshold of >15% in protracted...

FEX: WHO/TALC materials on the Management of Severe Malnutrition

Given the recent debate and rapidly evolving developments in the management of severe malnutrition, knowledge of current guidelines and training materials and how to access...

FEX: The relationship between wasting and stunting: policy, programming and research implications

Summary of review1 This summary was prepared by Tanya Khara, an independent consultant engaged by the ENN on this review. The review was made possible by the generous support...

FEX: Management of SAM in the Philippines: from emergency-focused modelling to national policy and government scale-up

By Aashima Garg, Anthony Calibo, Rene Galera, Andrew Bucu, Rosalia Paje and Willibald Zeck Lisez cet article en français ici Aashima Garg is Nutrition Specialist based...

FEX: Implementation of WHO Guidelines on the Management of Severe Malnutrition in South Africa and Ghana

Summary of published research1 Dietitian interacting with ward nurse at Mapuleng hospital, Northern Province, South Africa 2002 In the past, Field Exchange has addressed...

Close

Reference this page

Wasting in South Asia: Consultation on building the evidence base on the policy and programme response. Field Exchange 59, January 2019. p8. www.ennonline.net/fex/59/wastinginsouthasia