Monitoring changes in children and their mothers

Funded by the R2HC in 2015, ACF's research intends to assess the cost-effectiveness and long-term impact of a brief combined nutrition/psychosocial intervention (in comparison to a stand-alone nutritional treatment) on the growth and development of children with SAM aged 6 to 24 months in the Saptari District of Nepal.

During the last two years, eight female testers conducted home-based research testing for 427 SAM children. The pre-test was conducted within one week after the child was admitted in the CMAM programme. As per the research protocol, post-tests were administered after ten weeks, and again at 5 month follow up and 11 month follow up after admission. About 210 non-SAM children from the same community than SAM children were included in the testing protocol. During that period, thanks to their motivation and their hard work, they managed to maintain a good quality of follow up testing despite many challenges.

Who are the mothers and the children?

Boy, 13 months. Testing at 5th month after admission by Kabita

Boy, 13 months. Testing at 5th month after admission by Kabita

The overall status of the women in the district is very poor with minimal access to facilities and benefits. We identified many problems: lack of education, severe poverty, greater gender discrimination and discrimination between daughter and daughter-in-law, social and cultural rigidness, lack of decision-making freedom for women. Besides, most women could not feed their children properly even if they had proper knowledge about child care; they have to obey to their in-law parents’ instructions and decisions. Finally, many women face domestic violence (i.e. suppression, insult, blaming, harassment, financial control, scolding and beating, etc.)

Due to these reasons, it was difficult to convince the mothers or their in-law family to allow them some time for testing and anthropometry. In order to overcome this challenge, we respected the culture and the ethics of the community to build trust with the family because families often do not allow their daughter-in-law to talk separately with other unknown people. We then focused on rapport building with in-law-parents, other family members or community people where necessary.

Finally, seeing an improvement in the children’s health and child care practices was gratifying. At last, families were thankful and respectful which made us grateful towards our work as well.

Flexibility and adaptation to overcome challenges of a follow up testing

A child and a mother during child development test at baseline.

A child and a mother during child development test at baseline.

In terms of physical infrastructure, Saptari district is behind and the majority of communities are found in rural areas. Consequently, visiting households may take a maximum of 4 to 5 hours walking per day in most of the areas where we cannot go with a vehicle. Adding to this, seasonal challenges prevented us from walking or riding a bicycle for 3 to 4 hours: high temperature in summer season and muddy roads and floods in the rivers during the monsoon season. Finally, many rely on farming therefore we could not always catch mothers at home during busy planting and harvesting periods.

Politically, we faced many challenges during the six months blockade in 2015-2016 which greatly affected life in the district. As a result, it became more complicated to reach the families. Our work is very demanding in terms of rigor and planning. The quality of data depends mainly on our work and we respond to multiple tasks: timely testing of the mothers and their children, testing materials, tools, collecting quality and relevant data, scoring and timely submission of booklets, reporting of the field level issues and challenges, coordinating with OTPs as needed.

The coordination with health services is essential

Our work depends mainly on the activities within the Outpatient Treatment Programme (OTP). Prolonged health workers strike, late opening and early closing (from 11am to 2 pm) affect the quality of health services which also demotivates mothers to seek those services. As our work depends also on the quality of the information recorded in the Health Information Management System (HIMS), we frequently conducted home visits for data verification and correction comparing to HIMS records in order to maintain the quality of the data collected.

A learning process

During this period, we got the opportunity to learn about professionalism and job commitment thoroughly; we learnt the value of time and its management; the severity of malnutrition and its affect on a persons’ whole life; the overall situation of women in the district; we learnt how to deal with the communities/people and problems; we learnt how to work on a research project; we improved our knowledge and capacities regarding anthropometry measurement, child protection policy, child development, and child care practices which will help us further in our careers. In addition, we have improved our way of thinking and way of dealing with our own family members which has improved our own family relationship.

Elrha is hosted by Save the Children, a registered charity in England and Wales (213890) and Scotland (SC039570).

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