MUAC as the sole discharge criterion from community‐based management of severe acute malnutrition in Burkina Faso

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.

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

Journal of Health Research and Reviews ◽

10.4103/2394-2010.177492 ◽

2016 ◽

Vol 3 (1) ◽

pp. 20 ◽

Cited By ~ 1

Author(s):

ZubaidaLadan Farouk ◽

GarbaDayyabu Gwarzo ◽

Aisha Zango ◽

Halima Abdu

Keyword(s):

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

Community Based

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

BMJ Open ◽

10.1136/bmjopen-2017-017084 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017084 ◽

Cited By ~ 16

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.

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

Health Policy and Planning ◽

10.1093/heapol/czs070 ◽

2012 ◽

Vol 28 (4) ◽

pp. 386-399 ◽

Cited By ~ 54

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

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Sustainability and Scaling-Up Analysis of Community-Based Management of Acute Malnutrition: Lessons Learned from Burkina Faso

Food and Nutrition Bulletin ◽

10.1177/156482651303400306 ◽

2013 ◽

Vol 34 (3) ◽

pp. 338-348 ◽

Cited By ~ 10

Author(s):

Yassinmè Elysée Somassè ◽

Paluku Bahwere ◽

Samia Laokri ◽

Nazia Elmoussaoui ◽

Philippe Donnen

Keyword(s):

Burkina Faso ◽

Scaling Up ◽

Lessons Learned ◽

Acute Malnutrition ◽

Community Based

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Uptake of HIV testing and outcomes within a Community-based Therapeutic Care (CTC) programme to treat Severe Acute Malnutrition in Malawi: a descriptive study

BMC Infectious Diseases ◽

10.1186/1471-2334-8-106 ◽

2008 ◽

Vol 8 (1) ◽

Cited By ~ 31

Author(s):

Paluku Bahwere ◽

Ellen Piwoz ◽

Marthias C Joshua ◽

Kate Sadler ◽

Caroline H Grobler-Tanner ◽

...

Keyword(s):

Hiv Testing ◽

Severe Acute Malnutrition ◽

Descriptive Study ◽

Acute Malnutrition ◽

Community Based ◽

Therapeutic Care

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Comparing azithromycin to amoxicillin in the management of uncomplicated severe acute malnutrition in Burkina Faso: a pilot randomized trial

10.1101/2021.06.15.21258967 ◽

2021 ◽

Author(s):

Kieran S O'Brien ◽

Ali Sié ◽

Clarisse Dah ◽

Millogo Ourohire ◽

Moussa Ouédraogo ◽

...

Keyword(s):

Single Dose ◽

Weight Gain ◽

Adverse Events ◽

Burkina Faso ◽

Randomized Trial ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

World Health ◽

Promising Alternative

Introduction. Given the potential for asymptomatic infection in children with uncomplicated severe acute malnutrition (SAM), the World Health Organization recommends a broad-spectrum antibiotic like amoxicillin. Azithromycin is a promising alternative to amoxicillin as it can be administered as a single dose and has efficacy against several pathogens involved in the burden of infectious disease and mortality in this population. In this pilot study, we aimed to establish the feasibility of a larger randomized controlled trial and to provide preliminary evidence comparing the effect of azithromycin to amoxicillin on weight gain in children with uncomplicated SAM. Methods. This pilot randomized trial enrolled children 6-59 months old with uncomplicated SAM at 6 healthcare centers in Burkina Faso. Participants were randomized to a single dose of azithromycin or a 7-day course of amoxicillin. All participants received ready-to-use therapeutic food and were followed weekly until nutritional recovery and again at 8 weeks. The primary feasibility outcomes included enrollment potential, refusals, and loss to follow-up. The primary clinical outcome was weight gain (g/kg/day) over the 8-week period. Outcome assessors were masked. Results. Between June and October 2020, 312 children were screened, 301 were enrolled with 0 refusals, and 282 (93.6%) completed the 8-week visit. Average weight gain was 2.5 g/kg/day (SD 2.0) in the azithromycin group and 2.6 (SD) 1.7) in the amoxicillin group (Mean Difference -0.1, 95% CI -0.5 to 0.3, P = 0.63). Fewer adverse events were reported in the azithromycin group (Risk Ratio 0.50, 95% CI 0.31 to 0.82, P = 0.006). Conclusions. No differences were found in weight gain between groups. Given the ability to administer a single dose and the potential for fewer adverse events, azithromycin may be an alternative to amoxicillin for uncomplicated SAM. With strong enrollment and follow-up, a larger trial in this setting is feasible.

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