Community-based versus health facility-based management of acute malnutrition for reducing the prevalence of severe acute malnutrition in children 6 to 59 months of age in low- and middle-income countries

2013 ◽  
Author(s):  
Yasir Shafiq ◽  
Ali Saleem ◽  
Zohra S Lassi ◽  
Anita KM Zaidi
Keyword(s):  
Health Facility ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

scholarly journals Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 681
Author(s):  
Ritu Rana ◽  
Marie McGrath ◽  
Ekta Sharma ◽  
Paridhi Gupta ◽  
Marko Kerac
Keyword(s):  
At Risk ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Cochrane Library ◽  
Breastfeeding Support ◽  
Middle Income ◽  
Middle Income Countries ◽  
Breastfeeding Practices ◽  
Low And Middle Income

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother–infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

scholarly journals Decomposing the educational inequalities in the risk factors of severe acute malnutrition among under-five children in low and middle-income countries

2019 ◽  
Author(s):  
Adeniyi Francis Fagbamigbe ◽  
Ngianga- Bakwin Kandala ◽  
Olalekan Uthman
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Educational Inequalities ◽  
Middle Income ◽  
Under Five ◽  
Under Five Children ◽  
Middle Income Countries ◽  
Individual Household ◽  
The Individual ◽  
Low And Middle Income

Abstract Background Low- and Middle-income countries (LMIC) are still plagued with the burden of severe acute malnutrition (SAM). While studies have identified factors that influence SAM, efforts have not been made to decompose the educational inequalities across the individual, neighbourhood and national levels in LMIC. This study aims to decompose educational-related inequalities in the prevalence of SAM across LMIC.Methods We pooled successive secondary data from the Demographic and Health Survey (DHS) conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers (literate vs illiterate) was the main exposure variable. The explanatory variables cut across the individual-, household and neighbourhood-level factors of the mothers-children pair. Oaxaca-Blinder decomposition method was used to analyse the educational gap in the factors associated with SAM.Results Mothers with no formal education ranged from 0.1% in Armenia and Kyrgyz to as much as 86.1% in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8% compared with 4.2% among those whose mothers were educated. Thirteen countries had statistically significant pro-illiterate inequality (i.e. SAM concentrated among uneducated mothers) while none of the countries showed statistically significant pro-literate inequality. There were variations in the important factors responsible for the educational inequalities across the countries. On average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type.Conclusions We identified that SAM is prevalent in most LMIC with wide educational inequalities. The occurrence of SAM was explained by the individual, household and community-level factor. A potential strategy to reduce the burden of SAM to reduce educational inequalities among mothers in the low- and middle-income countries through the promotion of women education.

scholarly journals Decomposing the educational inequalities in the factors associated with severe acute malnutrition among under-five children in Low- and Middle-Income Countries

2020 ◽  
Author(s):  
Adeniyi Francis Fagbamigbe ◽  
Ngianga- Bakwin Kandala ◽  
Olalekan Uthman
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Educational Inequalities ◽  
Middle Income ◽  
Under Five ◽  
Factors Associated ◽  
Under Five Children ◽  
Middle Income Countries ◽  
The Individual ◽  
Low And Middle Income

Abstract Background: Low- and Middle-Income Countries (LMIC) have remained plagued with the burden of severe acute malnutrition (SAM). While studies have identified factors that influence SAM, efforts have not been made to decompose the educational inequalities across individual, neighbourhood and national level characteristics in LMIC. This study aims to decompose educational-related inequalities in the development of SAM among under-five children in LMIC and identify the risk factors that contribute to the inequalities. Methods: We pooled successive secondary data from the Demographic and Health Survey (DHS) conducted between 2010 and 2018 in 51 LMIC. We analysed data of 532,680 under-five children nested within 55,823 neighbourhoods. Severe acute malnutrition was the outcome variable while the literacy status of mothers (literate vs illiterate) was the main exposure variable. The explanatory variables cut across the individual-, household and neighbourhood-level factors of the mothers-children pair. Oaxaca-Blinder decomposition method was used to analyse the educational gap in the factors associated with SAM. Results: Mothers with no formal education ranged from 0.1 % in Armenia and Kyrgyz to as much as 86.1 % in Niger. The overall prevalence of SAM in the group of children whose mothers had no education was 5.8 % compared with 4.2 % among those whose mothers were educated. Thirteen countries had statistically significant pro-illiterate inequality ( p<0.05) while none of the countries showed statistically significant pro-literate inequality. There were variations in the significant factors associated with the educational inequalities across the countries studied. On the average, neighbourhood socioeconomic status disadvantage, location of residence were the most important factors in most countries. Other contributors to the explanation of educational inequalities are birth weight, maternal age and toilet type. Conclusions: We identified that SAM is prevalent in most LMIC with wide educational inequalities. The occurrence of SAM was explained by the individual, household and community-level factor. A potential strategy to reduce the burden of SAM is to reduce educational inequalities among mothers in the low- and middle- income countries through the promotion of women education as better education among all women will close the gaps and reduce the burden of SAM generally.

scholarly journals Management of severe acute malnutrition in low-income and middle-income countries

2014 ◽  
Vol 100 (3) ◽  
pp. 283-287 ◽  
Author(s):  
Indi Trehan ◽  
Mark J Manary
Keyword(s):  
Low Income ◽  
Rural Areas ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Environmental Enteropathy ◽  
Fortified Milk

Kwashiorkor and marasmus, collectively termed severe acute malnutrition (SAM), account for at least 10% of all deaths among children under 5 years of age worldwide, virtually all of them in low-income and middle-income countries. A number of risk factors, including seasonal food insecurity, environmental enteropathy, poor complementary feeding practices, and chronic and acute infections, contribute to the development of SAM. Careful anthropometry is key to making an accurate diagnosis of SAM and can be performed by village health workers or even laypeople in rural areas. The majority of children can be treated at home with ready-to-use therapeutic food under the community-based management of acute malnutrition model with recovery rates of approximately 90% under optimal conditions. A small percentage of children, often those with HIV, tuberculosis or other comorbidities, will still require inpatient therapy using fortified milk-based foods.

scholarly journals Evaluating malnutrition management through an intersectional lens: A case study of a community-based child malnutrition program in rural Uganda

2021 ◽  
Author(s):  
Marie-Catherine Gagnon-Dufresne ◽  
Geneviève Fortin ◽  
Kirsten Bunkeddeko ◽  
Charles Kalumuna ◽  
Kate Zinszer
Keyword(s):  
Gender Inequality ◽  
Acute Malnutrition ◽  
List Type ◽  
Structural Factors ◽  
Structural Determinants ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Malnourished Children ◽  
Low And Middle Income

ABSTRACTBackgroundIn Uganda, almost half of children under 5 years old suffer from undernutrition. Community-based management of acute malnutrition (CMAM) is recognized as an effective strategy for tackling this important global health issue. However, evaluations of CMAM programs are inconsistent and largely based on biomedical and behavioral health models, failing to incorporate structural factors influencing malnutrition management. Using an intersectional lens would allow to investigate the complex social processes shaping children’s care in CMAM programs. The aim of this evaluation was to understand and describe factors influencing malnutrition management in a CMAM program in rural Uganda, situating its findings within their social contexts using an intersectional approach.MethodsThis evaluation used qualitative methods to identify determinants linked to caregivers (micro-level), healthcare (meso-level) and societal structures (macro-level) that can influence children’s outpatient care. Data were collected from September to December 2019 at a community clinic through observations and interviews with caregivers of malnourished children. Data were coded in NVivo using thematic analysis. Intersectionality informed the interpretation of findings.ResultsWe observed 14 caregiver-provider encounters and interviewed 15 caregivers to assess factors hindering outpatient malnutrition management. Findings showed that caregivers had limited understanding of malnutrition and its mechanisms. The counselling offered was inconsistent and information given to caregivers about treatment preparation at home was insufficient. Gender inequality and poverty limited caregivers’ access to healthcare and their ability to care of their children. Factors at the micro and meso levels intersected with structural factors to influence malnutrition management.ConclusionResults suggest that CMAM programs would benefit from expanding support to caregivers by providing holistic interventions tackling structural barriers to children’s care. Using an intersectional approach to program evaluation could support improvement efforts by moving beyond individual determinants to address the social dynamics shaping the outpatient management of malnutrition in low- and middle-income countries.KEY MESSAGEMost evaluations of community-based management of acute malnutrition programs adopt biomedical or behavioral health models, while determinants beyond caregivers’ choices, behaviors, and practices can influence the outpatient management of child malnutrition. Managers and evaluators of these programs in low- and middle-income countries should also consider healthcare and structural determinants of care, to offer holistic interventions tackling the multifaceted barriers to programmatic success.KEY MESSAGESKey FindingsPoverty and gender inequality limited caregivers’ access to healthcare and their ability to comply with community-based management of acute malnutrition (CMAM) outpatient protocol.Nutritional counseling provided to caregivers was inconsistent, often including contradictory information about the treatment prescribed to children.Caregivers of malnourished children had a limited understanding of malnutrition and its underlying mechanisms.Key ImplicationsCMAM program evaluators should look beyond individual and behavioral factors and consider how healthcare and structural determinants interact with caregivers’ behaviors in influencing children’s outpatient care.CMAM program managers should expand support offered to caregivers by implementing holistic interventions tackling the multilevel barriers to malnutrition management to maximize programmatic success.Policymakers in Uganda and other low- and middle-income countries should develop national guidelines to fight malnutrition that seek to address the underlying determinants of child undernutrition, such as food insecurity, poverty, and women’s access to education and employment.

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