Research

Research

As a part of our research work we undertake the following surveys:

As a part of our research work we undertake the following surveys:

Standardized Monitoring and Assessment of Relief and Transition (SMART) survey: It is a standardized, simplified field survey methodology that produces snapshot of the current situation of malnutrition on the ground. This methodology is complemented with user friendly software known as ENA (Emergency Nutrition Assessment) software that has simplified functions to assist survey managers for sample size calculation, sample selection, quality checks and automated report generation. This methodology accurately provides prevalence of different types of malnutrition i.e. wasting, stunting and underweight along with information related to birth, death and migration.

Rapid SMART survey methodology: During an emergency, it is often difficult to undertake a SMART survey as we need to capture the emergency of a situation in a very short span of time. In order to establish an immediate response mechanism towards the levels of malnutrition found in the surveyed area, rapid SMART survey methodology is often used. In this survey, all principals of methodology remain the same except the sample size that is fixed at 200 children.

Link Nutrition Causal Analysis (NCA) study: This is a structured, participatory, holistic study design based on principals of UNICEF causal framework. This methodology not only provides information about prevalence of malnutrition but also links them with various causes directly affecting malnutrition in that specific geography.

We have conducted one NCA study in Burhanpur district of Madhya Pradesh. In India, about 20 to 25 individuals from various organizations have been trained to undertake this methodology.

Rapid Nutrition Assessment (RNA) survey:This is a rapid assessment methodology which can provide information about malnutrition status in very short span (2 – 4 days). This methodology provides information about prevalence of acute malnutrition as only mid upper arm circumference is measured to assess nutrition status of children.

We conducted 1 RNA in the state of Assam in India. An additional joint rapid nutrition assessment (JRNA) was conducted by us along with SPHERE in Assam during the Brahmaputra flooding.

So far, we have conducted eight SMART surveys in the following regions:

State No. of Surveys
Maharashtra 3
Odisha 2
Madhya Pradesh 2
Rajasthan 1

We have also supported UNICEF to conduct one SMART survey in Kerala.

Semi Qualitative Evaluation of Access and Coverage (SQUEAC) survey methodology: SQUEAC methodology is created to evaluate the coverage along with identifying barriers & boosters to CMAM programming. The information collected in this methodology is through triangulation of secondary, quantitative and qualitative data. This methodology is accepted as one of the key elements to successful implementation of CMAM across the globe.

Action Against Hunger has conducted one regional level training on SQUEAC methodology which was attended by 25 participants from across south East Asia.

Knowledge, Attitude and Practice (KAP) survey methodology: The methodology is largely used to understand the level of knowledge, attitude and practices regarding any intervention (infant and young child feeding, water sanitation and hygiene, nutrition, etc.) among the community. This methodology is semi-qualitative in nature and usually implemented as a baseline and end line KAP in program areas to understand the before and after change within the community.

So far we have conducted 4 KAP surveys on the topics related to infant and young child feeding and water, sanitation and hygiene in Madhya Pradesh, Maharashtra and Rajasthan.

Exhaustive assessment: This is a blanket survey methodology mainly used to create a census like survey in any geography. The exhaustive assessment is conducted to have a line listing of children under 5 within the program area to assess pervasiveness of issues at the household level. This methodology is used to create a baseline for any new program.

Action Against Hunger plans to undertake one such exhaustive assessment for WASH in three villages of Mokhada block in Palghar district.

Some of our survey reports are as follows:
  • SMART Survey in slum pockets of Govandi, Mumbai.
  • NUTRITION CAUSAL ANALYSIS and SMART SURVEY report.

Maharashtra is one of the first states in India that has piloted in March 2011 indigenous production of RUTF, and renamed it as Medical Nutrition Therapy (MNT). The MNT production is a very small-scale production unit situated in Mumbai within the Urban Health Center of Dharavi also known as Chota Sion Hospital. The unit was set up under the leadership of HoD pediatrics Dr Mamta Manglani along with Professor Dr Alka Jadhav of LTMG Hospital in partnership with IIT Mumbai – Centre for Technology Alternatives for Rural Areas (CTARA) department and Toddler Food Partners who provided technical support and funding in establishment of the manufacturing unit four years back in March 2011.

In this project, CTARA provides local technical knowledge, direction and personnel. Sion Hospital provides pediatric and nutritional staff and will produce MNT. Toddler Food Partners (TFP) provides technical support, expertise and training to get manufacturing up and running.

The goal of this project was to establish a manufacturing facility within Sion Hospital to make MNT (Medical Nutrition Therapy) for treating malnourished children from the slum area that the hospital serves.

Action Against Hunger proposed in 2013 to develop a partnership with LTMG Hospital. With the forecasted end of Toddler financial contribution by mid-2014, Action Against Hunger decided to contribute to the strengthening and extension of this project with additional technical expertise. A full time Food Technologist is employed by Action Against Hunger who has been involved in a daily monitoring and support of the activity, within the production unit.

A formal agreement was signed on June 2014 between Action Against Hunger and LTMGH by which Action Against Hunger will provide technical expertise on the Standard Operating Procedures (SOPs), and more specifically, will be involved in the following areas:

  • Building capacities of all the team members (Medical Officers, Dieticians, Production unit in charge and multipurpose worker) on the Standard Operating Procedures (SOPs) for MNT Production.
  • Providing technical expertise in upgrading the existing practices of manufacturing to the available standards in order to achieve a stabilized MNT as per the WHO specifications.
  • Conducting independent external laboratory testing to measure the quality of the MNT and ensure the adequacy with WHO specifications.
  • Scaling up the local production of standardized MNT to a larger capacity in order to cater to the needs of a larger number of children with SAM, by the end of the project.

The MNT is formulated based on WHO standards for RUTF following the same composition specifications of which all ingredients including micronutrient mix are procured locally.

Ingredients Composition in RUTF (%)
Peanut Paste 25.00
Skimmed Milk Powder (SMP) 24.15
Vegetable Oil 20.91
Powdered Sugar 28.17
Vitamins and Minerals 1.60
Emulsifier 0.60

The MNT is packaged in the form of a cup and the final product is procured locally by some NGOs for CMAM and some are utilized for in-patient treatment of admitted SAM cases. The current unit being relatively small has limited production capacity (maximum 1184 kgs per month) to cater to the needs of all SAM children in Mumbai. However, with very few NGOs working on SAM management in Mumbai/Maharashtra currently, we are confident to cater to the existing demand with some support in upgrading machinery to a higher batch capacity.