scholarly journals Data Driven Monitoring in Community Based Management of SAM children using Psychometric Techniques: An Operational Framework

2021 ◽  
Author(s):  
ANKUR JOSHI ◽  
Abhijit P Pakhare ◽  
Sivaja K Nair ◽  
G REVADI ◽  
MANOJ CHOUHAN ◽  
...  
Keyword(s):  
Item Difficulty ◽  
Severe Acute Malnutrition ◽  
Data Driven ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
Quadrant Analysis ◽  
Ability Estimation ◽  
Supportive Supervision ◽  
Community Based ◽  
Low Ability

Background- The success of the Community Based Management of Severe Malnutrition (CSAM)programme, largely depends on the knowledge and skills of Front-Line Workers (FLWs).A robust supportive supervision system in CSAM should be tailored to individualistic learning needs by distinguishing the FLWs as per their ability and simultaneously identifying the task domains to be emphasized more in supervisory visits.This paper details the ability assessment strategy developed and employed in the selected geographical locations in state of Madhya Pradesh (Central India) among the 197 Anganwadi workers (FLWs involved in CSAM implementation) Methodology-. A 25 items tool was developed based on an analytical construct for ability estimation through Rasch Analysis (RA). RA models the probability of right/wrong answer as a function of person(participants) and item (questions) parameters and calculates the item difficulty in relation with person ability on same unidimensional linear scale. The fitting of the data to Rasch model (Rasch diagnostic) was tested by both numeric (Anderson LR and Wald test) and graphical method. Suitable visualization like Item Characteristic Curve (ICC) and Person Item Map (PIM) were plotted in RA. Further a quadratic allocation of all AWWs into 4 quadrants were done as per the ability estimation (Rasch score) and adjusted numbers of SAM/MAM children in her center. Results-. . The item easiness parameter (β) value related to Diarrhoeal assessment was lowest (-2.32, -2.91 to -1.73) and related to peer assessment consequential action (2.009, 1.669- 2.348)) was highest (most difficult). Anderson LR test (LR=31.32, df=24, p=0.079) showed the absence of global outliers. Quadrant analysis using the permutations of ability score and adjusted burden of malnutrition further mapped 41/197 (20.8%) FLWs to low ability -high burden quadrant and 44/197(25%) as low ability low burden quadrant. Conclusion- RASCH assessment may address the innate challenges to maintain homogeneity, discrimination capacity and linearity in a raw score-based measurement construct. The monitoring strategy developed on this thus may offer a judicious, pragmatic and thematic approach to supportive supervision in CSAM program. Keywords: Severe Acute Malnutrition, RASCH assessment, data driven monitoring

scholarly journals A study on assessment of nutrition and health status of the children one year after discharge from the Nutritional Rehabilitation Centre in South India

2018 ◽  
Vol 5 (8) ◽  
pp. 3492
Author(s):  
C. Chandra Sekhar ◽  
D. Surendra Babu ◽  
C. Sravana Deepthi ◽  
Shakeer Kahn Patan ◽  
Khadervali N. ◽  
...  
Keyword(s):  
Health Status ◽  
Nutritional Status ◽  
Severe Acute Malnutrition ◽  
Cross Sectional Study ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
Rehabilitation Centre ◽  
Community Based ◽  
Cross Sectional ◽  
Danger Signs

Background: Nutrition rehabilitation centers (NRCs) were started to control severe malnutrition and follow-up of children with severe acute malnutrition is essential because mortality rate of 10-30% has been reported after discharge from hospital.Methods: A community based cross sectional study with the objectives to assess the current health status of the children discharged from the NRC and to assess the healthy practices learned by mothers during their stay at NRC. We included children those discharged from May to October 2013. The children were approached house to house visit and assessed for their health status with a pretested semi structured questionnaire. Mothers of the children were also interviewed for the knowledge and practices of the dietary and child care.Results: Among 67 children, 8 (11.9%) children could not be traced and 7 (10.4%) were reported dead, 52 were included 27 were boys and 25 were girls with a mean age of 35 months. The current nutritional status was 71.2% were not in very low weight, 17.3% were moderately underweight, and 11.5% were still severely underweight. Children who had more number of follow-ups had a better nutritional status which was significant (p<0.0001). 94% of the mothers had knowledge about correct feeding practices and food preparations; 86.5% were aware of good hygiene; 75% aware of the danger signs. Only 59.5% of the mothers could recollect the structured play therapy.Conclusions: Community based followup of the children following discharge from NRC and appropriate feedback to the mothers is very much essential for sustained results.

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)

Improving the outcome of severe acute malnutrition by community-based management

2016 ◽  
Vol 3 (1) ◽  
pp. 20 ◽  
Author(s):  
ZubaidaLadan Farouk ◽  
GarbaDayyabu Gwarzo ◽  
Aisha Zango ◽  
Halima Abdu
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based

scholarly journals Determinants of severe acute malnutrition among children under 5 years of age in Nepal: a community-based case–control study

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017084 ◽  
Author(s):  
Nilesh Kumar Pravana ◽  
Suneel Piryani ◽  
Surendra Prasad Chaurasiya ◽  
Rasmila Kawan ◽  
Ram Krishna Thapa ◽  
...  
Keyword(s):  
Educational Level ◽  
Case Control Study ◽  
Complementary Feeding ◽  
Severe Acute Malnutrition ◽  
Case Control ◽  
Acute Malnutrition ◽  
Community Based ◽  
Mother’S Age ◽  
Age At Birth ◽  
Control Study

BackgroundMalnutrition is one of the leading causes of morbidity and mortality among children under the age of 5 years in low and middle income countries like Nepal. Children with severe acute malnutrition (SAM) are nine times more likely to die than children without malnutrition. The prevalence of SAM has increased in Nepal over the past 15 years; however, the determinants of SAM have not been clearly assessed in the country.ObjectiveTo assess the determinants of SAM among children aged 6–59 months in the Bara district of Nepal.SettingA community-based case–control study was conducted in 12 randomly selected Village Development Committees (VDCs) of the Bara district of Nepal.ParticipantsA random sample of 292 children aged 6–59 months (146 as cases and 146 as controls) from 12 VDCs were included in this study.ResultsThe prevalence of SAM among children under the age of 5 years was 4.14%. The following factors were significantly associated with SAM: low socioeconomic status (adjusted odds ratio (AOR) 17.13, 95% CI 5.85 to 50.13); mother’s age at birth <20 or >35 years (AOR 3.21, 95% CI 1.30 to 7.94); birth interval <24 months (AOR 4.09, 95% CI 1.87 to 8.97); illiterate father (AOR 3.65, 95% CI 1.62 to 8.20); bottle feeding (AOR 2.19, 95% CI 1.73 to 12.03); and not initiating complementary feeding at the age of 6 months (AOR 2.91, 95% CI 1.73 to 12.03). Mother’s educational level, initiation of breastfeeding, colostrum feeding, and exclusive breastfeeding were not significantly associated with SAM.ConclusionThe mother's age at birth, birth interval, socioeconomic status, father’s educational level and initiation of complementary feeding at the age of 6 months were important determinants of SAM among children. A multi-sector approach is essential to address SAM. There is a need for further studies not only focusing on SAM but also moderate acute malnutrition.

scholarly journals The effects of malnutrition on cardiac function in African children

2015 ◽  
Vol 101 (2) ◽  
pp. 166-171 ◽  
Author(s):  
Jonathan A Silverman ◽  
Yamikani Chimalizeni ◽  
Stephen E Hawes ◽  
Elizabeth R Wolf ◽  
Maneesh Batra ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Function ◽  
Severe Acute Malnutrition ◽  
Resistance Index ◽  
Stroke Volume Index ◽  
Acute Malnutrition ◽  
Volume Index ◽  
Severe Malnutrition ◽  
Systemic Vascular Resistance Index ◽  
Malnourished Children

ObjectiveCardiac dysfunction may contribute to high mortality in severely malnourished children. Our objective was to assess the effect of malnutrition on cardiac function in hospitalised African children.DesignProspective cross-sectional study.SettingPublic referral hospital in Blantyre, Malawi.PatientsWe enrolled 272 stable, hospitalised children ages 6–59 months, with and without WHO-defined severe acute malnutrition.Main outcome measuresCardiac index, heart rate, mean arterial pressure, stroke volume index and systemic vascular resistance index were measured by the ultrasound cardiac output monitor (USCOM, New South Wales, Australia). We used linear regression with generalised estimating equations controlling for age, sex and anaemia.ResultsOur primary outcome, cardiac index, was similar between those with and without severe malnutrition: difference=0.22 L/min/m2 (95% CI −0.08 to 0.51). No difference was found in heart rate or stroke volume index. However, mean arterial pressure and systemic vascular resistance index were lower in children with severe malnutrition: difference=−8.6 mm Hg (95% CI −12.7 to −4.6) and difference=−200 dyne s/cm5/m2 (95% CI −320 to −80), respectively.ConclusionsIn this largest study to date, we found no significant difference in cardiac function between hospitalised children with and without severe acute malnutrition. Further study is needed to determine if cardiac function is diminished in unstable malnourished children.

scholarly journals Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

2012 ◽  
Vol 28 (4) ◽  
pp. 386-399 ◽  
Author(s):  
Chloe Puett ◽  
Kate Sadler ◽  
Harold Alderman ◽  
Jennifer Coates ◽  
John L. Fiedler ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Community Based

scholarly journals An Experience at a Tertiary Level Hospital NRC in Management of Severe Acute Malnutrition in Children Aged between 6-59 Months Adopting World Health Organization Recommendations

2016 ◽  
Vol 1 (1) ◽  
pp. 41 ◽  
Author(s):  
S. Bharathi ◽  
K. Anuradha ◽  
J. Venkateshwar Rao
Keyword(s):  
World Health Organization ◽  
Severe Acute Malnutrition ◽  
Case Fatality ◽  
Acute Malnutrition ◽  
World Health ◽  
Severe Malnutrition ◽  
Rehabilitation Center ◽  
Nutritional Rehabilitation ◽  
Retrospective Case ◽  
Health Organization

<p><em>Objectives:<strong> </strong></em><em>To study the outcome indicators of a nutritional rehabilitation center and to assess its performance.</em></p><p><em>Design: </em><em>Retrospective case study.</em></p><p><em>Period:</em><em> One year period from Jan 2014 to Dec 2014.</em></p><p><em>Methods:<strong> </strong></em><em>Data of 254 children aged between 6-59</em><em> </em><em>months with severe acute malnutrition admitted in nutritional rehabilitation center at department of pediatrics, Gandhi hospital, was</em><em> </em><em>analyzed retrospectively. Identification and treatment of severe acute malnutrition was done according to world health organization recommendations.</em></p><p><em>Results:<strong> </strong></em><em>The recovery rate, death rate, defaulter rate, mean (SD) weight gain &amp; mean (SD) duration of stay in the nutritional rehabilitation center were 51.42%, 3.54%, 28.57%, 8g/kg/day, 14.2 days respectively.</em></p><p><em>Conclusions:<strong> </strong></em><em>Nutritional rehabilitation centers are effective in management of severe malnutrition and also in decreasing the case fatality rates.</em></p>

scholarly journals Lessons Learned from Community-based Management of Acute Malnutrition (CMAM) Programmes that Operate in Fragile or Conflict Affected Settings

2021 ◽  
Author(s):  
Evert-jan Quak
Keyword(s):  
Health System ◽  
Local Governments ◽  
Severe Acute Malnutrition ◽  
Lessons Learned ◽  
Childhood Development ◽  
Acute Malnutrition ◽  
Rapid Review ◽  
Surveillance Systems ◽  
Low Literacy ◽  
Community Based

This rapid review synthesises the literature on how community-based management of acute malnutrition (CMAM) programmes could be adapted in settings of conflict and fragility. It identifies multiple factors affecting the quality and effectiveness of CMAM services including the health system, community engagement and linkages with other programmes, including education, sanitation, and early childhood development. Family MUAC (Mid-Upper Arm Circumference) is a useful tool to increase community participation and detect early cases of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) more effectively and less likely to require inpatient care. The literature does not say a lot about m-Health solutions (using mobile devises and applications) in data collection and surveillance systems. Many of the above-mentioned issues are relevant for CMAM programmes in settings of non-emergency, emergency, conflict and fragility. However, there are special circumstance in conflict and fragile settings that need adaptation and simplification of the standard protocols. Because of a broken or partly broken health system in settings of conflict and fragility, local governments are not able to fund access to adequate inpatient and outpatient treatment centres. NGOs and humanitarian agencies are often able to set up stand-alone outpatient therapeutic programmes or mobile centres in the most affected regions. The training of community health volunteers (CHVs) is important and implementing Family MUAC. Importantly, research shows that: Low literacy of CHVs is not a problem to achieve good nutritional outcomes as long as protocols are simplified. Combined/simplified protocols are not inferior to standard protocols. However, due to complexities and low funding, treatment is focused on SAM and availability for children with MAM is far less prioritised, until they deteriorate to SAM. There is widespread confusion about combined/simplified protocol terminology and content, because there is no coherence at the global level.

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