scholarly journals Filling the Gaps for Community-Based Programs Managing Treatment and Prevention of Child Malnutrition in Non-Emergency Contexts: Results from the Rainbow Project 2015-17 in Zambia

2018 ◽  
Author(s):  
Stefania Moramarco ◽  
Giulia Amerio ◽  
Jean Kasengele Chipoma ◽  
Karin Nielsen-Saines ◽  
Leonardo Palombi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
International Standards ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Average Weight ◽  
Program Outcomes ◽  
Community Based ◽  
Predictors Of Mortality ◽  
Feeding Programs ◽  
Treatment And Prevention

Background: Evaluation of nutrition programs is essential to guarantee the effectiveness of community-based management of acute malnutrition (CMAM). Methods: The Rainbow Project Supplementary Feeding Programs (SFPs) in Zambia were evaluated between years 2015-17, following implementation of new recommendations based on previous evaluations (years 2012-14). Outcomes of the program were compared with International Standards and with those of 2012-14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: Data for 900 under age 5 years malnourished children (48.8% male; mean age 19.7months ±9.9) were analyzed. Rainbow 2015-17 program outcomes met International Standards, for general malnutrition or stratified moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). When comparing with 2012-14 outcomes, better performance was noted: mortality rates were reduced by half (5.6% vs 3.1%, p = 0.01; for SAM: 12.4% vs 6.7%, p = 0.006), with significant improvement in average weight gain and mean length of stay (p<0.001), and increased awareness of HIV status (+30%; p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ < −3 at baseline (4.6; 1.3–16.1) and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Conclusion: The effectiveness of the Rainbow SFPs for child malnutrition treatment and prevention in Zambia has significantly improved after evaluation and implementation activities, with impressive outcomes which resulted in a 50% reduction in mortality.

scholarly journals Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

2018 ◽  
Vol 15 (9) ◽  
pp. 1807 ◽  
Author(s):  
Stefania Moramarco ◽  
Giulia Amerio ◽  
Jean Kasengele Chipoma ◽  
Karin Nielsen-Saines ◽  
Leonardo Palombi ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Integrated Management ◽  
International Standards ◽  
Acute Malnutrition ◽  
Child Malnutrition ◽  
Average Weight ◽  
Community Based ◽  
Predictors Of Mortality ◽  
Feeding Programs ◽  
Treatment And Prevention

Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.

scholarly journals Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Amare Kassaw ◽  
Desalegne Amare ◽  
Minyichil Birhanu ◽  
Aragaw Tesfaw ◽  
Shegaw Zeleke ◽  
...  
Keyword(s):  
Public Health ◽  
Oxygen Saturation ◽  
Retrospective Cohort ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Altered Consciousness ◽  
Time To Death ◽  
Under Five ◽  
Predictors Of Mortality ◽  
Malnourished Children

Abstract Background Malnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers. Methods A facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance. Results Out of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition. Conclusion The overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

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 Performance and costing of nutrition intervention measures on admitted children in malnutrition treatment center: a case study from Jharkhand, India

2020 ◽  
Vol 7 (10) ◽  
pp. 4048
Author(s):  
Rajesh Kumar Sinha ◽  
Asha Kiran ◽  
Vivek Kashyap ◽  
Praveen Kumar
Keyword(s):  
Severe Acute Malnutrition ◽  
Average Length ◽  
Nutrition Intervention ◽  
Acute Malnutrition ◽  
Treatment Center ◽  
Medical Complication ◽  
Average Weight ◽  
Post Discharge ◽  
Target Weight ◽  
Intervention Measures

Background: Children with severe acute malnutrition (SAM) having medical complications require immediate care at malnutrition treatment centers (MTC). Thus, it becomes important to assess the effect and treatment cost of such children in these facilities. Hence, the present study was done with these aims in two MTCs in Jharkhand, India.Methods: A retrospective record review was done of the children admitted to these two MTCs between 1st April 2017 and 31st March 2018. A predesigned proforma was used to collect child related information. The data collected was entered in Microsoft excel sheet and analysed.Results: Majority of the admitted children (90.6%) were in 6-23 months age group. 358 (51.5%) children were females. Only, 194 (27.9%) children admitted were SAM had any medical complication. 690 (99.3%) children were discharged of whom 499 (72.3%) were discharged after achieving the target weight. The average weight gain during their stay was 8.1±2.4 g/kg/day and average length of stay was 16.7±3.2 days. Post discharge follow up rates were found to be low and only 130 (18.8%) children completed all three follow ups. Average cost per SAM child treated was Rs. 18,599 (US$ 272) and per SAM child cured was Rs. 25,904 (US$ 379).Conclusions: MTCs are effective in managing medically complicated SAM children. However, improvements are necessary to ensure that more such children should be treated at facility level, complimented with a community based programme for managing uncomplicated SAM children to improve coverage and ensure continuum of care.

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.

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