The April Nutrition Society Paper of the Month is from Public Health Nutrition  from the Médecins Sans Frontières/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.’

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 recognize 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 the 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.

MSF in Darbhanga, Bihar

In close collaboration with the Bihar State Health Society, MSF has, since 2009, treated more than 17,000 SAM children aged between six months and five years. Its CMAM model 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, and a stabilization centre/Nutritional Rehabilitation Unit (NRU) at the block level to treat SAM with minor complications. Additionally, at the district level, in collaboration with the Darbhanga Medical College and Hospital, a Malnutrition Intensive Care Unit (MICU) was set up in March 2014 to treat SAM patients with serious medical complications. So far, the MICU has treated more than 300 complicated cases of SAM in the district. To know more about the project in Bihar, please see:

This paper is freely available for one month via the following link:

Nutrition Society Paper of the Month

Each month a paper is selected by one of the Editors of the five Nutrition Society Publications (British Journal of Nutrition, Public Health Nutrition, Nutrition Research Reviews, Proceedings of the Nutrition Society and Journal of Nutritional Science). This paper is freely available for one month.

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