Tracking Weight-for-Age of Infants Using Home Based Newborn Care Plus by ASHA Workers

Background Malnutrition in all its forms remains a serious global concern, particularly affecting children, a highly vulnerable population group. Home visits during the first year of life using the community worker platform is an unexplored opportunity for making improvements in nutritional status. Objective To analyze the nutritional status (weight for age) of a cohort of infants between 3 and 12 months of age. Design Tracking weight for age of infants by ASHA workers. Settings 13 districts in the states of Bihar, Madhya Pradesh, Odisha and Rajasthan. Intervention Home visits under a home-based newborn care program, home-based newborn care plus (HBNC+). Methods Norway India Partnership Initiative (NIPI) project supported implementation of HBNC+, in 13 districts across four states in India. A descriptive analysis of infants based on retrospective record based program data was done. The nutritional status (weight-for-age) of the cohort was analyzed. Categories were defined based on the z -scores of weight for age (≤−3 SD; ≤−2 SD and > −3 SD; and > −2 SD). Trend of malnutrition and proportions of children in each category at 3, 6, 9 and 12 months were assessed. Results At 3 months of age, out of 3,50,986 infants provided home visits, 1,82,049 (51.9%) were underweight as per WHO definition with weight for age z -score ≤− 2 SD; this reduced to 11.1% at 12 months of age. Difference of means at 3 months and 12 months significantly different for weight for age z -score ( P <0.001). There was a decline in the proportion of children in severe and moderate malnutrition categories by 15% and 26%, respectively. Conclusion Catch-up growth in terms of weight-for-age among malnourished children is possible within one year of age. Frequent contacts with the health care functionaries may result in this improvement, though it is difficult to conclude in the absence of an appropriate control.