Costs and cost-effectiveness of three point-of-use water treatment technologies added to community-based treatment of severe acute malnutrition in Sindh Province, Pakistan

AbstractObjectiveTo evaluate effectiveness of point-of-use water treatment in improving treatment of children affected by severe acute malnutrition (SAM).DesignProgramme sites were randomized to one of four intervention arms: (i) standard SAM treatment; (ii) SAM treatment plus flocculent/disinfectant water treatment; (iii) SAM treatment plus chlorine disinfectant; or (iv) SAM treatment plus ceramic water filter. Outcome measures were calculated based on participant status upon exit or after 120d of enrolment, whichever came first. Child anthropometric data were collected during weekly monitoring at programme sites. Child caregivers were interviewed at enrolment and exit. Use of water treatment products was assessed in a home visit 4–6 weeks after enrolment.SettingDadu District, Sindh Province, Pakistan.SubjectsChildren (n 901) aged 6–59 months with SAM and no medical complications.ResultsRecovery rates were 16·7–22·2 % higher among children receiving water treatment compared with the control group. The adjusted odds of recovery were approximately twice as high for those receiving water treatment compared with controls. Mean length of stay until recovery was 73 (sd 24·6) d and mean rate of weight gain was 4·7 (sd 3·0) g/kg per d. Differences in recovery rate, length of stay and rate of weight gain between intervention groups were not statistically significant.ConclusionsIncorporating point-of-use water treatment into outpatient treatment programmes for children with SAM increased nutritional recovery rates. No significant differences in recovery rates were observed between the different intervention groups, indicating that different water treatment approaches were equally effective in improving recovery.

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Community-based Clinical Trial With Microbiota Directed Complementary Foods (MDCFs) Made of Locally Available Food Ingredients for the Management of Children With Post-severe Acute Malnutrition Moderate Acute Malnutrition (Post-SAM MAM)

Case Medical Research ◽

10.31525/ct1-nct04015986 ◽

2019 ◽

Author(s):

Keyword(s):

Clinical Trial ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Complementary Foods ◽

Community Based ◽

Food Ingredients ◽

Moderate Acute Malnutrition

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Methods, Protocols, Guidance and Standards for Performance Evaluation for Point-of-Use Water Treatment Technologies: History, Current Status, Future Needs and Directions

Water ◽

10.3390/w13081094 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1094

Author(s):

Emily S. Bailey ◽

Nikki Beetsch ◽

Douglas A. Wait ◽

Hemali H. Oza ◽

Nirmala Ronnie ◽

...

Keyword(s):

Drinking Water ◽

Water Treatment ◽

Enteric Bacteria ◽

Current Status ◽

Household Water Treatment ◽

Produce Water ◽

Point Of Use ◽

Treatment Technologies ◽

Injury And Repair ◽

Testing Protocols

It is estimated that 780 million people do not have access to improved drinking water sources and approximately 2 billion people use fecally contaminated drinking water. Effective point-of-use water treatment systems (POU) can provide water with sufficiently reduced concentrations of pathogenic enteric microorganisms to not pose significant health risks to consumers. Household water treatment (HWT) systems utilize various technologies that physically remove and/or inactivate pathogens. A limited number of governmental and other institutional entities have developed testing protocols to evaluate the performance of POU water treatment systems. Such testing protocols are essential to documenting effective performance because inferior and ineffective POU treatment technologies are thought to be in widespread use. This critical review examines specific practices, procedures and specification of widely available POU system evaluation protocols. Testing protocols should provide standardized and detailed instructions yet be sufficiently flexible to deal with different treatment technologies, test microbe priorities and choices, testing facility capabilities and public health needs. Appropriate infectivity or culture assays should be used to quantify test enteric bacteria, viruses and protozoan parasites, or other appropriate surrogates or substitutes for them, although processes based on physical removal can be tested by methods that detect microbes as particles. Recommendations include further research of stock microbe production and handling methods to consistently yield test microbes in a realistic state of aggregation and, in the case of bacteria, appropriately physiologically stressed. Bacterial quantification methods should address the phenomenon of bacterial injury and repair in order to maximally recover those that are culturable and potentially infectious. It is only with harmonized national and international testing protocols and performance targets that independent and unbiased testing can be done to assure consumers that POU treatment technologies are able to produce water of high microbial quality and low health risk.

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Coverage Assessment For Community-Based Management Of Acute Malnutrition In Rural And Urban Ghana: A Comparative Cross-Sectional Study.

10.21203/rs.3.rs-43723/v2 ◽

2021 ◽

Author(s):

Joana Apenkwa ◽

Sam K Newton ◽

Samuel Kofi Amponsah ◽

Reuben Osei-Antwi ◽

Emmanuel Nakua ◽

...

Keyword(s):

Severe Acute Malnutrition ◽

Qualitative Approach ◽

Rural District ◽

Urban Setting ◽

Acute Malnutrition ◽

Rural Setting ◽

Community Based ◽

Cross Sectional ◽

Study District ◽

Point Coverage

Abstract Background: Ghana for years has implemented the Community-based Management of Acute Malnutrition (CMAM) among children in order to reduce malnutrition prevalence. However, the prevalence of malnutrition remains high. This study aimed to determine CMAM coverage levels in the Ahafo Ano South (AAS), a rural district, and Kumasi Subin sub-metropolis (KSSM), an urban district. Methods: The study was a cross-sectional comparative study with a mixed-methods approach. In all, 497 mother/caregiver and child under-five pairs were surveyed using a quantitative approach while qualitative methods were used to study 25 service providers and 40 mother/ caregivers who did not participate in the quantitative survey. Four types of coverage indicators were assessed: point coverage (defined as the number of Severe Acute Malnutrition cases [SAM] in treatment divided by total number of Severe Acute Malnutrition cases in the study district), geographical coverage (defined as total number of health facilities delivering treatment for SAM divided by total number of healthcare facilities in the study district), and treatment coverage (defined as children with SAM receiving therapeutic care divided by total number of SAM children in the study district) and program coverage (defined as number of SAM cases in the CMAM programme ÷ Number of SAM cases that should be in the programme). The qualitative approach was used to support the assessment of the coverage indicators. Data were analyzed using STATA version 14, and Atlas.ti, version 7.5 for the quantitative and qualitative data respectivelyResults: Geographically, only 6% of the facilities in the urban communities were participating in the CMAM programme as against 29% of rural district facilities. The districts had point coverage of 41% and 10% for the urban and rural districts respectively. The urban setting recorded a SAM prevalence of 52% as against 36% in the rural setting. The proportion of SAM children enrolled in CMAM was higher in KSSM when compared with AAS; 41% and 33% respectively. In both districts, the most likely factors to attract mothers/caregivers to utilize the CMAM services were: ‘free services’ and ‘a cured child.’ The qualitative approach showed that coverage improvement in both districts is hampered by barriers such: distance, transportation cost, lack of trained personnel in the communities for community mobilization and home visits, and insufficient feeds. Conclusion: To improve CMAM coverage, there is the need to train health workers to embark on aggressive health education strategies to encourage mothers/caregivers of malnourished children to utilize CMAM while ensuring that services reach those who need them. Trial registration: This study is approved and registered with The Kwame Nkrumah University of Science and Technology Committee on Human Research, Ethics and Publications (CHRPE/AP/314/15)

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