scholarly journals Literacy is power: structural drivers of child malnutrition in rural Liberia

2020 ◽  
pp. bmjnph-2020-000140
Author(s):  
Odell W Kumeh ◽  
Mosoka P Fallah ◽  
Ishaan K Desai ◽  
Hannah N Gilbert ◽  
Jason B Silverstein ◽  
...  
Keyword(s):  
Social Protection ◽  
Health Workers ◽  
Virus Disease ◽  
Severe Acute Malnutrition ◽  
Feeding Practices ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Structural Factors ◽  
Structural Barriers ◽  
Depth Interviews

BackgroundIn Liberia, an estimated 32% of children under 5 are stunted. Malnutrition and hunger worsened during the country’s civil war and were further exacerbated by the 2014–2016 outbreak of Ebola virus disease. Studies examining adherence to recommended infant and young child feeding practices frequently do so with an emphasis on the knowledge, attitudes and beliefs of mothers and caregivers. Often overlooked are the structural factors that enable or constrain their agency to practise evidence-based recommendations.MethodsBetween July and December 2017, we surveyed 100 Liberian mothers to assess the sociodemographic factors associated with the risk of severe acute malnutrition in children in Maryland County, Liberia. We also conducted 50 in-depth interviews at two government health facilities to qualitatively explore mothers’ experiences, as well as health workers’ understandings of the determinants of malnutrition in the region. We applied logistic regression to analyse quantitative data and inductive content analysis to thematically interpret qualitative data.ResultsMothers were less likely to have a child with severe acute malnutrition if they had an income greater than US$50 per month (adjusted OR (aOR)=0.14, p<0.001), were literate (aOR=0.21, p=0.009) or exclusively breast fed during the first 6 months of life (aOR=0.18, p=0.049); they were more likely to have a child with severe acute malnutrition if they were married or in domestic partnerships (aOR=8.41, p<0.001). In-depth interviews elucidated several social, economic and programmatic factors that shaped suboptimal feeding practices, as well as decisions for and against seeking formal care for malnutrition.DiscussionThe lived experiences of Liberian mothers and health workers illustrate that child malnutrition is a direct consequence of abject poverty, food insecurity, illiteracy, the precarious nature of formal and informal work, and the lack of robust social protection. Behaviour change and health education interventions that do not seek to alleviate structural barriers to compliance are unlikely to be effective.

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 A Feasibility Study to Assess Non-clinical Community Health Workers’ Capacity to use Simplified Protocols and Tools to Treat Severe Acute Malnutrition in Niger State Nigeria

2021 ◽  
Author(s):  
Olatunde Adesoro ◽  
Olusola Oresanya ◽  
Helen Counihan ◽  
Prudence Hamade ◽  
Dare Eguavon ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Full Recovery ◽  
Childhood Mortality ◽  
Acute Malnutrition ◽  
Community Case Management ◽  
Integrated Community Case Management ◽  
Clinical Community

Abstract Background: Severe acute malnutrition (SAM) is a major determinant of childhood mortality and morbidity. Although integrated community case management (iCCM) of childhood illnesses is a strategy for increasing access to life-saving treatment, malnutrition is not properly addressed in the guidelines. This study aimed to determine whether non-clinical Community Health Workers (called Community-Oriented Resource Persons, CORPs) implementing iCCM could use simplified tools to treat uncomplicated SAM.Methods: The study used a sequential mixed-method design and was conducted between July 2017 and May 2018. Sixty CORPs already providing iCCM services were trained and deployed in their communities with the target of enrolling 290 SAM cases. Competency of CORPs to treat and the treatment outcomes of enrolled children were documented. SAM cases with MUAC of 9cm to < 11.5cm without medical complications were treated for up to 12 weeks. Full recovery was at MUAC≥12.5cm for two consecutive weeks. Supervision and quantitative data capturing were done weekly while qualitative data were collected after the intervention.Results: CORPs scored 93.1% on first assessment and increment of 0.11 (95% CI: 0.05 – 0.18) points per additional supervision conducted. The cure rate from SAM to full recovery, excluding referrals from the denominator in line with the standard for reporting SAM recovery rates, was 73.5% and the median length of treatment was seven weeks. SAM cases enrolled at 9cm to <10.25cm MUAC had 29% less likelihood of recovery compared to those enrolled at 10.25cm to <11.5cm. CORPs were not burdened by the integration of SAM into iCCM and felt motivated by children’s recovery. Operational challenges like bad terrains for supervision, supply chain management and referrals were reported by supervisors, while Government funding was identified as key for sustainability.Conclusion: The study demonstrated that with training and supportive supervision, CORPs in Nigeria can treat SAM among under-fives, and refer complicated cases using simplified protocols as part of an iCCM programme. This approach seemed acceptable to all stakeholders, however, the effect of the extra workload of integrating SAM into iCCM on the quality of care provided by the CORPs should be assessed further.

scholarly journals Dietary determinant of severe acute malnutrition among infants: Evidence from a case controlled study at a Central Indian district

2016 ◽  
Vol 6 (1) ◽  
pp. 32-39 ◽  
Author(s):  
Pavan Pandey ◽  
Shivendra Kumar Singh
Keyword(s):  
Complementary Feeding ◽  
Severe Acute Malnutrition ◽  
Sampling Strategy ◽  
Feeding Practices ◽  
Acute Malnutrition ◽  
World Health ◽  
Controlled Study ◽  
P Value ◽  
Health Organization ◽  
And Control

Breast feeding and complementary feeding practices ultimately determine the nutritional status of newborn at the end of infancy. The objective of the present study was to find the possible causes of malnutrition in context of breastfeeding and complementary feeding practices adopted by families of infants aged 6-12 month old. A community-based, unmatched, case-controlled study was conducted involving 78 cases and 156 controls in the Raisen district of Madhya Pradesh, India. The study included infants aged 6- 12 months who were enrolled in the Integrated Child Development Scheme. Cases and controls were selected through a multi-staged sampling strategy. Cases were those with severe acute malnutrition and controls were those with no malnutrition as per the World Health Organization criteria. Data related to the breastfeeding, pre-lacteal feeding and complementary feeding practices were collected using a pre-tested questionnaire. Descriptive and bivariate analyses were carried out. P-value and Odds ratios were calculated. The proportion of exclusive breastfeeding among cases and control was 10.3% and 24.4% respectively. The high odds of malnutrition were related to lack of exclusively breastfeeding [COR(95% CI) = 4.69(2.50- 6.53)], lack of feeding semisolid food, less frequent complementary feedings [COR(95% CI) = 5.69(3.01- 8.93)], lack of hand washing by caregivers [COR(95% CI) =2.44 (1.10-3.19)], and lack of use of disinfected drinking water for infants. Proper health education should be imparted not only to mothers but also other family members involved in the child’s care.South East Asia Journal of Public Health Vol.6(1) 2016: 32-39

scholarly journals Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers: results from a large-scale pragmatic trial in rural Niger

2016 ◽  
Vol 74 (1) ◽  
Author(s):  
Franck G.B. Alé ◽  
Kevin P.Q. Phelan ◽  
Hassan Issa ◽  
Isabelle Defourny ◽  
Guillaume Le Duc ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Focal Point ◽  
Severe Acute Malnutrition ◽  
Pragmatic Trial ◽  
Acute Malnutrition ◽  
Upper Arm ◽  
Arm Circumference ◽  
Mid Upper Arm Circumference

Abstract Background Community health workers (CHWs) are recommended to screen for acute malnutrition in the community by assessing mid-upper arm circumference (MUAC) on children between 6 and 59 months of age. MUAC is a simple screening tool that has been shown to be a better predictor of mortality in acutely malnourished children than other practicable anthropometric indicators. This study compared, under program conditions, mothers and CHWs in screening for severe acute malnutrition (SAM) by color-banded MUAC tapes. Methods This pragmatic interventional, non-randomized efficacy study took place in two health zones of Niger’s Mirriah District from May 2013 to April 2014. Mothers in Dogo (Mothers Zone) and CHWs in Takieta (CHWs Zone) were trained to screen for malnutrition by MUAC color-coded class and check for edema. Exhaustive coverage surveys were conducted quarterly, and relevant data collected routinely in the health and nutrition program. An efficacy and cost analysis of each screening strategy was performed. Results A total of 12,893 mothers and caretakers were trained in the Mothers Zone and 36 CHWs in the CHWs Zone, and point coverage was similar in both zones at the end of the study (35.14 % Mothers Zone vs 32.35 % CHWs Zone, p = 0.9484). In the Mothers Zone, there was a higher rate of MUAC agreement (75.4 % vs 40.1 %, p <0.0001) and earlier detection of cases, with median MUAC at admission for those enrolled by MUAC <115 mm estimated to be 1.6 mm higher using a smoothed bootstrap procedure. Children in the Mothers Zone were much less likely to require inpatient care, both at admission and during treatment, with the most pronounced difference at admission for those enrolled by MUAC < 115 mm (risk ratio = 0.09 [95 % CI 0.03; 0.25], p < 0.0001). Training mothers required higher up-front costs, but overall costs for the year were much lower ($8,600 USD vs $21,980 USD.) Conclusions Mothers were not inferior to CHWs in screening for malnutrition at a substantially lower cost. Children in the Mothers Zone were admitted at an earlier stage of SAM and required fewer hospitalizations. Making mothers the focal point of screening strategies should be included in malnutrition treatment programs. Trial registration The trial is registered with clinicaltrials.gov (Trial number NCT01863394).

Current and Potential Role of Specially Formulated Foods and Food Supplements for Preventing Malnutrition among 6- to 23-Month-Old Children and for Treating Moderate Malnutrition among 6- to 59-Month-Old Children

2009 ◽  
Vol 30 (3_suppl3) ◽  
pp. S434-S463 ◽  
Author(s):  
Saskia de Pee ◽  
Martin W. Bloem
Keyword(s):  
Severe Acute Malnutrition ◽  
Essential Fatty Acids ◽  
Food Supplements ◽  
Complementary Food ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Malnourished Children ◽  
Nutrient Density ◽  
Animal Source ◽  
The Impact

Reducing child malnutrition requires nutritious food, breastfeeding, improved hygiene, health services, and (prenatal) care. Poverty and food insecurity seriously constrain the accessibility of nutritious diets that have high protein quality, adequate micronutrient content and bioavailability, macrominerals and essential fatty acids, low antinutrient content, and high nutrient density. Diets based largely on plant sources with few animal-source and fortified foods do not meet these requirements and need to be improved by processing (dehulling, germinating, fermenting), fortification, and adding animal-source foods, e.g., milk, or other specific nutrients. Options include using specially formulated foods (fortified blended foods, commercial infant cereals, or ready-to-use foods [RUFs; pastes, compressed bars, or biscuits]) or complementary food supplements (micronutrient powders or powdered complementary food supplements containing micronutrients, protein, amino acids, and/or enzymes or lipid-based nutrient supplements (120 to 250 kcal/day), typically containing milk powder, high-quality vegetable oil, peanut paste, sugar, and micronutrients. Most supplementary feeding programs for moderately malnourished children supply fortified blended foods, such as corn–soy blend, with oil and sugar, which have shortcomings, including too many antinutrients, no milk (important for growth), suboptimal micronutrient content, high bulk, and high viscosity. Thus, for feeding young or malnourished children, fortified blended foods need to be improved or replaced. Based on success with ready-to-use therapeutic foods (RUTFs) for treating severe acute malnutrition, modifying these recipes is also considered. Commodities for reducing child malnutrition should be chosen on the basis of nutritional needs, program circumstances, availability of commodities, and likelihood of impact. Data are urgently required to compare the impact of new or modified commodities with that of current fortified blended foods and of RUTF developed for treating severe acute malnutrition.

scholarly journals Determinants of severe acute malnutrition in children between six months to five year of age enrolled in nutritional rehabilitation centre at a tertiary care level

2019 ◽  
Vol 6 (6) ◽  
pp. 2489
Author(s):  
Gargi H. Pathak ◽  
Anuya V. Chauhan ◽  
Sunita O. Beniwal
Keyword(s):  
Nutritional Status ◽  
Severe Acute Malnutrition ◽  
Tertiary Care ◽  
Feeding Practices ◽  
Well Being ◽  
Acute Malnutrition ◽  
Nutritional Rehabilitation ◽  
Rehabilitation Centre ◽  
Under Five ◽  
History Of

Background: Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well-being of a society at large. Malnutrition stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors.  In order to holistically address the issues surrounding malnutrition, a comprehensive understanding of the multi-dimensional complexities at play in society is crucial. Objective was to identify determinants of severe acute malnutrition among children with severe acute malnutrition under 5 years (between 6 months to 60 months) of age. Methods: A cross sectional study design involving 64 patients with severe acute malnutrition between 6 to 60 month of age was employed to identify the risk factors of severe acute malnutrition among children admitted in pediatric wards and nutritional rehabilitation centers, Civil hospital Ahmedabad, from April 2018 to march 2019. A detailed history of all the patients were taken and data collected using structured interviewer-administered questionnaire.Results: Thus, from the above study, it is clear  that age of the child <2 years, female gender, bigger family size, poverty, illiteracy in mother, poor feeding practices, improper complementary feed introduction, poor nutritional status of mother whose child were breastfed, acute or chronic illness in child and narrow birth spacing were the chief determinants of SAM in under five children.Conclusions: Socio demographic characters, nutrition and child caring practices, infection and other childhood illness as well as obstetric history of mother are important determinants of severe acute malnutrition in children under five years of age. As a result, collaborative efforts should be organized to improve promotion of better child caring practices through appropriate age specific child and maternal feeding practices, prevention and early treatment of acute childhood illnesses and promotion of family planning.

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