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BackgroundMalnutrition in children is widely prevalent around the world. It has been observed that malnourished children with multiple anthropometric deficits have higher mortality. However, adequate studies are not available on the outcome and recovery of these children.Nandurbar, a tribal district from Maharashtra, India, shows high prevalence of all three forms of malnutrition, often occurring simultaneously. A project previously undertaken in Nandurbar from July 2014 to June 2016 studied the effect of various therapeutic feeds in treatment of children with uncomplicated severe acute malnutrition (SAM). In this study, we analyse secondary data from it to correlate effects of stunting, wasting and underweight on treatment recovery.MethodsAnalysis was done on 5979 children with SAM using linear and logistic regression on R software for recovery rates and weight gain in children with SAM with single versus multiple anthropometric deficits, their relation to age, sex, and recovery from severe stunting by gain in height.ResultsThe mean age of children was 35 months and 53.1% of the children were males. 2346 (39.2%) children recovered at the end of the 8-week treatment. 454 (7.6%) had single anthropometric deficit (SAM only), 3164 (52.9%) had two anthropometric deficits (SAM and severe underweight (SUW)) and 2355 (39.4%) children had three anthropometric deficits (SAM, SUW and severe stunting). Out of the 5979 children with SAM, only 52 (0.9%) of children were not underweight (severe or moderate).44.94% of children with SAM who were severely stunted recovered, compared with 35.52% of children who were not (p<0.001). After controlling for confounders, severe stunting was found to increase the odds of recovery by 1.49. Severely stunted children with SAM also showed faster recovery and weight gain by 1.93 days (p<0.012) and 0.29 g/kg/day (p<0.001), respectively. Recovery was higher in females and younger age group. Recovery was also found to depend on the therapeutic feed, with children receiving medical nutrition therapy showing better recovery for severely stunted children.ConclusionOur findings corroborate previous literature that stunting is a way for the body to deal with chronic stress of nutritional deprivation and provides a survival advantage to a child.

The early years in a child’s life are ‘critical’ as synaptic connections in the brain form and mature in this period. A child’s potential for development becomes irreversibly reduced if these early years are not enriched in a stimulating physical and psychosocial environment. Elucidating the underlying technical scientific concepts related to brain development to lay persons is a challenge specially in low-and-middle-income countries like India with limited literacy and/or ignorance. If these technical concepts are to be taken to the last person, across the last mile then simple, effective, acceptable solutions need to be metamorphosed for the local context considering the cultural, social and economic constraints.Brain wiring game is a participatory activity that helps to sensitize the audience about the ‘sculpting’ role of experiences on synapse formation and brain development during the early years. It evolved in 2018, during the preparatory phase of a field implementation research for empowering caregivers on Nurturing care being implemented in 4 districts of Maharashtra, India. Since then, it has been played with more than 200,000 individuals representing an entire spectrum from rural, urban and tribal areas, irrespective of their literacy status or socio-economic background. It has been played in a variety of settings ranging from classroom training sessions, field training sessions, mothers’ meetings at village level, Palak melawa (Community fair for Parents), sensitization meetings and community-based events. The participants who have been sensitized through this include parents, other caregivers, frontline health workers, para-medical staff, village council representatives and health professionals.