The Foundation for Mother and Child Health (FMCH) is a grassroots organisation working in the slums of Mumbai. Resources were targeted to pregnant mothers, infants and young children (aged up to three years) through a ‘1,000 days initiative’. Programming involved active growth monitoring from birth with early and intensive interventions using contextualised nutrition and breastfeeding counselling tools (45 counselling points emphasising ‘cross-cradle hold’), clinic follow-up, home visits and community/peer group support sessions. Innovative technology supported weight monitoring (software), counselling and health-worker training (online videos). Data analysis from a cohort of 286 children followed between 2013 and 2016 found that underweight fell by 47.5%, stunting fell by 18.7% and wasting fell by 16.7% (severe wasting fell by 67.7%) between baseline (average age 2.2 months) and endline (average age 13.9 months). In a cohort of 80 children followed to 25.9 months (average), decreases were recorded in prevalence of underweight (33%); stunting (28.1%) and severe wasting (40%), but wasting increased (by 33.3%). Data from a small cohort of infants (n=51) supported by newly trained government health workers and tracked from birth until the fourth week of life found good average weight-gain rates (37g/kg/d). The experiences indicate that contextualised, targeted, quality counselling focusing on critical moments in the lifecycle is necessary and effective. Close growth monitoring from birth is critical to track progress and inform early action. Training and supervision of the existing health workforce to support service quality is needed and possible in a low-resource, challenging setting.
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