scholarly journals Description of a community paediatric strategy offering a package of services to prevent malnutrition among children in one health district in Mali

2021 ◽  
Author(s):  
Thomas Roederer ◽  
Augusto E. Llosa ◽  
Susan Shepherd ◽  
Isabelle Defourny ◽  
Michel-Olivier Lacharité ◽  
...  
Keyword(s):  
One Health ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Scale Up ◽  
Health Indicators ◽  
Food Distribution ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Health Area

AbstractBackgroundWe present results from an intervention case study, the Soins Preventifs de l’Enfant (SPE) project, in Konséguéla health area, Mali. The intervention involved a network of community health workers providing a comprehensive preventive/therapeutic package, ultimately aiming at reducing under 24-month mortality. Associated costs were documented to assess the feasibility of replication and scale-up.MethodsSPE program monitoring data were obtained from booklets specific to the program between 2010 and 2014. Data included sex, age, vaccination status, anthropometric measurements, Ready-To-Use-Supplementary Food distribution, morbidities reported by the mother between visits, hospitalizations over 18 months of follow-up. Cross-sectional surveys in the district of Koutiala, of which Konséguéla is one health area, were conducted yearly between 2010 and 2014 for comparison, using difference-in-difference approach. Ethical approval was granted from the Malian Ethical Committee.ResultsGlobal and Severe Acute Malnutrition prevalences decreased over time in Konséguéla as well as in the rest of the district, but the difference between areas was not significant. Children reaching 24 months were 20% less stunted in Konséguéla than children the same age outside (p<0.001). Mortality rates significantly decreased more in Konséguéla, while vaccination coverage for all antigens significantly increased in the meantime. The package cost approximately USD 95 per child per year; 56% of which was for the RUSF.ConclusionThe results of this case study suggest a sustained impact of a community based, comprehensive health package on major child health indicators. Most notably, while improvements in acute malnutrition were found in the district as a whole, those in the intervention area were more pronounced. Trends for other indicators suggest additional benefits.

scholarly journals Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan

2017 ◽  
Vol 21 (2) ◽  
pp. 385-390 ◽  
Author(s):  
Eleanor Rogers ◽  
Muhammad Ali ◽  
Shahid Fazal ◽  
Deepak Kumar ◽  
Saul Guerrero ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Supervision And Training ◽  
Mid Upper Arm Circumference ◽  
The Impact ◽  
Care Study

AbstractObjectiveTo assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community.DesignCross-sectional quality-of-care study.SettingThe feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model.SubjectsLHW implementing treatment for uncomplicated SAM in the community.ResultsOedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %.ConclusionsThis quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.

scholarly journals Who could be One Health Activist at the community level?: A case for India

2020 ◽  
Author(s):  
Sandul Yasobant ◽  
Walter Bruchhausen ◽  
Deepak Saxena ◽  
Farjana Zakir Memon ◽  
Timo Falkenberg
Keyword(s):  
Health System ◽  
Financial Incentives ◽  
One Health ◽  
Health Workers ◽  
Structured Interview ◽  
Communicable Diseases ◽  
Community Level ◽  
System Level ◽  
Cross Sectional

Abstract Background: Community Health Workers (CHWs) are the mainstay of the public health system, serving for decades in low resource countries. Their multi-dimensional work in diverse health care services, including the prevention of communicable diseases and health promotion for non-communicable diseases, are making CHWs the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of the western cities of India, Ahmedabad, targeted to identify OHA by exploring the motivation to become an OHA in a local setting.Methods: This case study explores two major CHWs i.e. female (Accredited Social Health Activists-ASHA) and male (multipurpose male health worker) on their motivation for becoming an OHA. The data was collected between September 2018 and August 2019 through a mixed design i.e. quantitative data (cross-sectional structured questionnaire) and qualitative data (focus group discussion with a semi-structured interview guide). Results: The motivation of the CHWs for OHA was found to be low. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. ASHAs were found to be willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Conclusion: The high demotivation of CHWs that has been documented on the individual, community, and health system level needs to be urgently addressed in future policies.

scholarly journals A quantitative cross-sectional survey of psychosocial stimulation and counselling interventions at nutritional rehabilitation units in Southern Malawi

2019 ◽  
Vol 31 (4) ◽  
pp. 238-243
Author(s):  
Allison I Daniel
Keyword(s):  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Limited Information ◽  
Nutritional Rehabilitation ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Psychosocial Stimulation ◽  
Counselling Interventions

BackgroundInpatient treatment at nutritional rehabilitation units (NRUs) is needed for children who have severe acute malnutrition (SAM) and acute illness, loss of appetite, or severe oedema. World Health Organization guidelines state that nutritional counselling should be done with primary caregivers at NRUs. These recommendations also include psychosocial stimulation interventions to improve developmental outcomes in children with SAM. However, there is limited information about the delivery of these types of interventions for caregivers and children in NRU settings. The primary objective of this research was therefore to obtain data about NRU resources, activities, and protocols relevant to psychosocial stimulation and counselling interventions during inpatient treatment of children with SAM. MethodsA cross-sectional survey was administered by interview at all 16 NRUs in seven districts in Southern Malawi. Participants were health workers, nurses, and nutritionists employed at the respective NRUs. ResultsThe response rate was 100% across NRUs. Half of participants said that psychosocial stimulation interventions are conducted at their respective NRUs, yet none of the NRUs have protocols for delivery of these interventions. Furthermore, 7/16 (44%) NRUs have no resources for psychosocial stimulation including play materials. Thirteen of 16 (81%) participants said that they feel this type of intervention is very important and 3/16 (19%) participants said that this somewhat important for children with SAM. All NRUs provide counselling to caregivers about breastfeeding and nutrition; 15/16 (94%) also give counselling about water, sanitation and hygiene. ConclusionsUltimately, results from this survey highlighted that there is a need to invest in comprehensive interventions to improve developmental and nutritional outcomes in these vulnerable children requiring admission to NRUs. 

scholarly journals Incidence Correction Factors for Moderate and Severe Acute Child Malnutrition From 2 Longitudinal Cohorts in Mali and Burkina Faso

2020 ◽  
Vol 189 (12) ◽  
pp. 1623-1627
Author(s):  
Francisco M Barba ◽  
Lieven Huybregts ◽  
Jef L Leroy
Keyword(s):  
Burkina Faso ◽  
Low Income ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Incidence Data ◽  
Moderate Acute Malnutrition ◽  
Cluster Randomized ◽  
Definition Of ◽  
Mid Upper Arm Circumference

Abstract Child acute malnutrition (AM) is an important cause of child mortality. Accurately estimating its burden requires cumulative incidence data from longitudinal studies, which are rarely available in low-income settings. In the absence of such data, the AM burden is approximated using prevalence estimates from cross-sectional surveys and the incidence correction factor $K$, obtained from the few available cohorts that measured AM. We estimated $K$ factors for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) from AM incidence and prevalence using representative cross-sectional baseline and longitudinal data from 2 cluster-randomized controlled trials (Innovative Approaches for the Prevention of Childhood Malnutrition—PROMIS) conducted between 2014 and 2017 in Burkina Faso and Mali. We compared K estimates using complete (weight-for-length z score, mid-upper arm circumference (MUAC), and edema) and partial (MUAC, edema) definitions of SAM and MAM. $K$ estimates for SAM were 9.4 and 5.7 in Burkina Faso and in Mali, respectively; K estimates for MAM were 4.7 in Burkina Faso and 5.1 in Mali. The MUAC and edema–based definition of AM did not lead to different $K$ estimates. Our results suggest that $K$ can be reliably estimated when only MUAC and edema-based data are available. Additional studies, however, are required to confirm this finding in different settings.

scholarly journals Who could be One Health Activist at the community level?: A case for India

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sandul Yasobant ◽  
Walter Bruchhausen ◽  
Deepak Saxena ◽  
Farjana Zakir Memon ◽  
Timo Falkenberg
Keyword(s):  
Health System ◽  
Work Experience ◽  
Financial Incentives ◽  
One Health ◽  
Health Workers ◽  
Structured Interview ◽  
Communicable Diseases ◽  
Community Level ◽  
System Level

Abstract Background Community health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries. Their multi-dimensional work in various health care services, including the prevention of communicable diseases and health promotion of non-communicable diseases, makes CHWs, the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of India’s western cities, Ahmedabad, targeted identifying OHA by exploring the feasibility and the motivation of CHWs in a local setting. Methods This case study explores two major CHWs, i.e., female (Accredited Social Health Activists/ASHA) health workers (FHWs) and male (multipurpose) health workers (MHWs), on their experience and motivation for becoming an OHA. The data were collected between September 2018 and August 2019 through a mixed design, i.e., quantitative data (cross-sectional structured questionnaire) followed by qualitative data (focus group discussion with a semi-structured interview guide). Results The motivation of the CHWs for liaisoning as OHA was found to be low; however, the FHWs have a higher mean motivation score [40 (36–43)] as compared to MHWs [37 (35–40)] out of a maximum score of 92. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. Comparing the female and male health workers to act as OHA, higher motivational score, multidisciplinary collaborative work experience, and way for incentive generation documented among the female health workers. Conclusion ASHAs were willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Although this study documented various systemic factors at the individual, community, and health system level, which might, directly and indirectly, impact the acceptance level to act as OHA, they need to be accounted for in the policy regime.

scholarly journals Clinico-epidemiological profile of acute respiratory infections and malnutrition in urban and rural population of central India

2016 ◽  
Vol 4 (1) ◽  
pp. 159
Author(s):  
Pranav G. Jawade ◽  
Neelam D. Sukhsohale ◽  
Gayatri G. Jawade ◽  
Binish Z. A. Khan ◽  
Pratik K. Kakani ◽  
...  
Keyword(s):  
Rural Population ◽  
Urban Population ◽  
Respiratory Infections ◽  
Severe Acute Malnutrition ◽  
Pediatric Population ◽  
Central India ◽  
Developing Nations ◽  
Acute Malnutrition ◽  
Acute Respiratory Infections ◽  
Cross Sectional

Background: Acute respiratory infections (ARI) and Malnutrition in children have tremendous burden on the health care sector of developing nations including India. The intensity with which these conditions are holding grip in the community is indeed a matter of concern and hence developing nations should develop an insight to assess the severity of it has become a necessity.Methods: A hospital based cross sectional study was carried out in children aged 0-14 years. Children were clinically assessed and diagnosis was made as URTI or LRTI Also anthropometry was performed and accordingly children were divided into categories of no malnutrition (NM), severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) in ‘under 5’ years age children according to WHO guidelines, whereas children aged ‘above 5’ years were categorized as per the IAP guidelines.Results: It was observed that most of the mothers of children were illiterate with inadequate or absent ventilation and use of biomass fuels (chulha) for cooking purpose in households of rural children. The proportion of malnutrition was found to be equal in Under 5 children. In ‘above 5 years’ age study subjects, 52.4% of urban study subjects were normal as compared to 16.7% of rural study subjects.Conclusions: Our study implies that ARI and Malnutrition definitely is more prevalent in the pediatric population. Prevalence of URTI was found to be on a higher side in the rural population and LRTI prevalence was found to be higher in the urban population. Similarly, the prevalence of malnutrition was almost similar in ‘Under 5’ aged children, whereas the prevalence of malnutrition in ‘Above 5’ aged children was higher in the rural population than urban population.

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

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)

scholarly journals Prevalence of hypoglycemia in diarrheal dehydration at hospitalization in severe acute malnutrition

2018 ◽  
Vol 5 (3) ◽  
pp. 1092 ◽  
Author(s):  
Rameshwar Ninama ◽  
Chakshu Chaudhry ◽  
Rameshwar Lal Suman ◽  
Suresh Goyal ◽  
Ramprakash Prakash Bairwa ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Acute Diarrhea ◽  
Severe Acute Malnutrition ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Severe Dehydration ◽  
Cross Sectional ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Average Blood Glucose

Background: Diarrhea is the major cause of death in children below five years of age. Hypoglycemia has been a potential fatal complication of infectious diarrhea in both well-nourished and poorly nourished children. But prevalence of hypoglycemia in diarrheal dehydration is not exactly known. This study was done to evaluate the glycemic status in children having acute diarrhea with dehydration and specifically associated with severe acute malnutrition (SAM).Methods: This descriptive cross-sectional study was conducted during July 2017 to December 2017 at Bal Chikitsalaya Udaipur, Rajasthan, India. Blood glucose levels were assessed in 150 children of acute diarrhea with dehydration, comprising of 100 SAM and 50 Non SAM children.Results: Average blood glucose of SAM children was 89 mg/dl and of non-SAM, it was 120 mg/dl. Average blood glucose was low in SAM as compared to non-SAM in both some dehydration (116.08±21.26) and severe dehydration (66.69±19.80) as well as with or without ORS intake. Overall 18 (12%) of children had hypoglycemia and all were in severe dehydration and not taking ORS. Blood glucose levels were statistically low in severe dehydration and those who were not taking ORS at the time of hospitalization (p = 0.001). In severe dehydration 25% of children had hypoglycemia means every fourth child had low blood glucose <54 mg/dl.Conclusions: Overall prevalence of hypoglycemia is 12% in diarrheal dehydration and 20% in SAM with dehydration. Twenty five percent of severe dehydration children had hypoglycemia, and all have not started ORS. None of the child started ORS developed hypoglycaemia.

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