Bottlenecks and met needs for the treatment of severe acute malnutrition in pastoralists: Doolo zone of Somali region, Ethiopia.

2020 ◽  
Author(s):  
Abdifatah Elmi Farah ◽  
Abdulahi Haji Abas ◽  
Ahmed Tahir Ahmed
Keyword(s):  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Supply Side ◽  
Health Extension Workers ◽  
Treatment Coverage ◽  
Somali Region ◽  
Average Treatment ◽  
Regional State ◽  
Quality Aspects ◽  
Met Needs

Abstract Background There is high burden of malnutrition worldwide, including wasting that is compromising growth and development of children and nations. In Ethiopia, severe acute malnutrition (SAM) remains a public health problem. Prevalence of acute malnutrition i.e. wasting is highest (22.7%), (17.5 %) in Somali region of Ethiopia. This study assessed the bottlenecks and met needs for SAM treatment coverage in Doolo zone Somali regional state of Ethiopia. Methods This study used Tanahashi model of service coverage to identify bottlenecks for SAM treatment coverage at health facility platform using multi-stage sampling in Doolo zone, Somali regional state of Ethiopia. T racer interventions were selected to make the analysis more manageable and systematic. The collected data were entered in to excel then thoroughly cleaned and analysed. Indicators for supply-side, demand and quality were calculated. The shortest bar of the graph was considered as a bottleneck for supply-side while sharp decline or drop-in between one bar of the graph to the next was considered as a bottleneck in demand and quality sides. Performance thresholds were set for the indicators as (Good, fair and poor) and met need for SAM was then calculated.ResultThe analysis identified bottlenecks across the six determinants of coverage for the treatment of SAM. Major supply-side bottlenecks identified were commodity stock-outs, mainly ready to use therapeutic foods (RUTF) and shortage of trained health extension workers in three of the four districts studied. On the demand side, despite reasonable initial utilizations in most of the districts studied, there were poor continuity of services (high defaulter rate) and low quality of SAM treatment (effective coverage). The met need was lowest in Bokh district (12%) and highest in Danod district (70%). Despite average treatment coverages of 85% and above for Geladi, Warder and Danod districts, yet the met need was found to be 54%, 60% and 70% respectively which was not commensurate with average treatment coveragesConclusionThe identified bottlenecks for SAM treatment coverage cut across the supply side, demand and quality aspects. The low quality for SAM treatment could have resulted from a combination of supply and demand bottlenecks i.e. frequent stock out of basic commodities (RUTF), shortage of trained health extension workers and poor health-seeking behaviour and/or poor continuity of service or high defaulter rate). The overall met need for SAM program was found to be 37% which could imply high unmet need and poor impact of the program. It is recommended that further causality analysis be undertaken for the major bottlenecks discovered in this study to establish root causes of bottlenecks and devise appropriate solutions adapted to the local setting.

scholarly journals Effectiveness of screening and treatment of children with severe acute malnutrition by community health workers in Simiyu region, Tanzania: a quasi-experimental pilot study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Calistus Wilunda ◽  
Fortihappiness Gabinus Mumba ◽  
Giovanni Putoto ◽  
Gloria Maya ◽  
Elias Musa ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Intervention Group ◽  
Control Area ◽  
Acute Malnutrition ◽  
Control Group ◽  
Treatment Coverage ◽  
Quasi Experimental

AbstractHealth system constraints hamper treatment of children with severe acute malnutrition (SAM) in Tanzania. This non-inferiority quasi-experimental study in Bariadi (intervention) and Maswa (control) districts assessed the effectiveness, coverage, and cost-effectiveness of SAM treatment by community health workers (CHWs) compared with outpatient therapeutic care (OTC). We included 154 and 210 children aged 6–59 months with SAM [mid-upper arm circumference (MUAC) < 11.5 cm] without medical complications in the control and intervention districts, respectively. The primary treatment outcome was cure (MUAC ≥ 12.5 cm). We performed costing analysis from the provider’s perspective. The probability of cure was higher in the intervention group (90.5%) than in the control group (75.3%); risk ratio (RR) 1.17; 95% CI 1.05, 1.31 and risk difference (RD) 0.13; 95% CI 0.04, 0.23. SAM treatment coverage was higher in the intervention area (80.9%) than in the control area (41.7%). The cost per child treated was US$146.50 in the intervention group and US$161.62 in the control group and that per child cured was US$161.77 and US$215.49 in the intervention and control groups, respectively. The additional costs per an additional child treated and cured were US$134.40 and US$130.92, respectively. Compared with OTC, treatment of children with uncomplicated SAM by CHWs was effective, increased treatment coverage and was cost-effective.

scholarly journals Exploring opportunities to enhance effectiveness of mobile health and nutrition strategy for providing health and nutrition services amongst pastoralists in Somali region, Ethiopia

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Olusola Oladeji ◽  
Bibilola Oladeji ◽  
Mohamed Diaaeldin Omer ◽  
Abdifatah Elmi Farah ◽  
Ida M. Ameda ◽  
...  
Keyword(s):  
Mobile Health ◽  
Severe Acute Malnutrition ◽  
Critical Role ◽  
Health Facilities ◽  
Acute Malnutrition ◽  
Access To Health Services ◽  
Somali Region ◽  
Nutrition Services ◽  
Health And Nutrition ◽  
Nutrition Strategy

Background: The health system in Ethiopia’s Somali Region is weak with limited number of health facilities with more than 60% of the population living more than 5 km to the nearest health facilities. The deployment of mobile health and nutrition teams has played critical role in providing essential health and nutrition services.Aim: This study aimed to assess the effectiveness of the mobile health and nutrition strategy in providing health and nutrition services in the targeted woredas (districts).Setting: Somali Region of Ethiopia.Methods: The study was a retrospective chart review of the monthly mobile health and nutrition team and the static health facilities in the 29 woredas between April 2019 and March 2020 and the AccessMod analyses for geographical accessibility to health facilities in the region.Results: 40 (40.4%) out of the 99 woredas in Somali regions have at least 80% of the population living more than 5 km from the nearest health facility out of which 18 (45%) woredas are currently being supported by the mobile health team. The mobile team contributed to increasing access to health services in the targeted woredas with 30.8% of the total children vaccinated for measles and 39% of the total children treated for severe acute malnutrition in the targeted 29 woredas.Conclusion: With mobile health and nutrition strategy being recognised as a useful strategy to deliver health and nutrition services in the region, there is a need to explore opportunities and innovation to enhance the effectiveness of the implementation.

scholarly journals Impact of Integration of Severe Acute Malnutrition Treatment in Primary Health Care Provided by Community Health Workers in Rural Niger

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 4067
Author(s):  
Abdias Ogobara Dougnon ◽  
Pilar Charle-Cuéllar ◽  
Fanta Toure ◽  
Abdoul Aziz Gado ◽  
Atté Sanoussi ◽  
...  
Keyword(s):  
Community Health ◽  
Community Health Workers ◽  
Group Treatment ◽  
Outpatient Treatment ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Intervention Group ◽  
Acute Malnutrition ◽  
Control Group ◽  
Treatment Coverage

The present study aimed to assess the effectiveness and impact on treatment coverage of integrating severe acute malnutrition (SAM) treatment at the health hut level by community health workers (CHWs). This study was a non-randomized controlled trial, including two rural communes in the health district of Mayahi: Maïreyreye (control) and Guidan Amoumoune (intervention). The control group received outpatient treatment for uncomplicated SAM from health facilities (HFs), while the intervention group received outpatient treatment for uncomplicated SAM from HFs or CHWs. A total of 2789 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 72.1% in the control group, and 77.2% in the intervention group. Treatment coverage decreased by 8.3% in the control area, while the group of CHWs was able to mitigate that drop and even increase coverage by 3%. This decentralized treatment model of acute malnutrition with CHWs allowed an increase in treatment coverage while maintaining a good quality of care. It also allowed the early inclusion of children in less severe conditions. These results may enhance the Niger Ministry of Health to review the management of SAM protocol and allow CHWs to treat acute malnutrition.

scholarly journals Coverage Assessment for Community-based Management of Acute Malnutrition in Rural and Urban Ghana: A Comparative Cross Sectional Study

2020 ◽  
Author(s):  
Joana Apenkwa ◽  
Sam K Newton ◽  
Samuel Kofi Amponsah ◽  
Reuben Osei-Antwi ◽  
Emmanuel Nakua ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Qualitative Approach ◽  
Rural District ◽  
Acute Malnutrition ◽  
Community Based ◽  
Cross Sectional ◽  
Treatment Coverage ◽  
Rural Districts ◽  
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 coverage levels of CMAM in 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. Results Treatment coverage in the urban and rural districts were 73% and 6% respectively. Geographically, only 6% of the facilities in the urban communities were participating in the CMAM programme as against 29% in rural district facilities. The two districts had point coverage of 81% and 71% for the urban and rural districts respectively. The number of children enrolled in CMAM was higher among the AAS respondents when compared with KSSM; 56.9% and 90% respectively. 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 Coverage Validation survey for lymphatic filariasis treatment in Itang special district of Gambella regional state of Ethiopia; Cross sectional study

2020 ◽  
Author(s):  
Abinet Teshome ◽  
Zerihun Zerdo ◽  
Mekuria Asnakew ◽  
Chuchu Churko ◽  
Manaye Yihune ◽  
...  
Keyword(s):  
Lymphatic Filariasis ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Target Population ◽  
Health Extension Workers ◽  
Preventive Chemotherapy ◽  
Cross Sectional ◽  
Treatment Coverage ◽  
Regional State ◽  
Special District

Abstract Background Coverage validation survey provides a more precise estimate of preventive chemotherapy coverage and avoids the biases, as well as some of the errors that can affect reported coverage. This coverage validation survey was done to know the difference between the reported coverage from district of Itang special for Ivermectin and Albendazole given for Lymphatic Filariasis with the actual coverage in the selected district. Methods Itang special district from Gambella region was purposively selected for lymphatic filariasis treatment coverage survey. The survey was done by using segments from each district whereby 30 segments were selected from the district. The name of the kebeles and the segments where the survey was carried out were selected by using random selection method. After getting the total number of households in each selected kebele from the village chief the number of segments to be visited was computed by dividing the number of households to 50 and 16 households were visited from each segment and eligible individuals aged 5 and above were interviewed. Data for variables related to coverage of the IVM plus ALB were collected using Survey CTO software. Location of each household and the kebele chief office was recorded by using Global positioning system. Information about the kebele including population size, number of households in the kebele, last dates of mass drug administration were gathered primarily from village chiefs when available and headmasters and health extension workers when unavailable. Results The coverage validation survey result shows that the coverage for lymphatic Filariasis treatment was 81.5% in Itang special district of Gambella regional state. From 825 individuals that reported that they were offered the treatment 823(99.6%) swallowed the drug. The main reason for not being offered ivermectin and Albendazole during the mass drug administration campaigns because they were missing class during those dates (37.2%). Conclusion The data collected from Itang special woreda of Gambella Region shows that the treatment coverage is higher than the recommended coverage of 65% of the target population should be treated. Different factors play a role for this achievement including using different treatment sites such as schools, community centers and home to home by using health development armies for those children not attending schools and for nomadic communities such as the one in Gambella Regional state. Keywords Lymphatic Filariasis, Ivermectin, Albendazole, Coverage

scholarly journals Factors associated with child survival in children admitted to outpatient therapeutic program at public health institutions in Afar Regional State, Ethiopia: a prospective cohort study

2019 ◽  
Vol 38 (1) ◽  
Author(s):  
Misgan Legesse Liben ◽  
Abel Gebre Wuneh ◽  
Reda Shamie ◽  
Kiros G/her
Keyword(s):  
Public Health ◽  
Vitamin A ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Vitamin A Supplementation ◽  
Therapeutic Program ◽  
Regional State ◽  
Public Health Institutions ◽  
Health Institutions ◽  
Outpatient Therapeutic Program

Abstract Introduction About 20 million children suffer from severe acute malnutrition each year. The World Health Organization recommends the outpatient therapeutic program as a standard treatment protocol for the management of uncomplicated severe acute malnutrition and for children who are transferred from inpatient cares after recovery. This study aimed to assess the treatment outcome of severe acute malnutrition and determinants of survival in children admitted to outpatient therapeutic program at public health institutions, Afar Regional State. Methods Institution-based prospective cohort study was conducted on 286 children aged 6–59 months admitted to the outpatient therapeutic program, from April to September 2017, at selected public health institutions in Afar Regional State. For the comparison of time to recovery among the different groups of children on the outpatient therapeutic program, Kaplan-Meir curve was used and significance test for these differences was assessed by the log-rank test. Then, a proportional hazard in the Cox model was used to identify independent predictors of survival. p value < 0.05 was considered significant. Results Of 286 children, 238 (83.2%; 95% CI (79, 88)), 18 (6.3%), 14 (4.9%), 8 (2.8%), and 8 (2.8%) cases were cured, defaulters, non-responder, died, and transfer to inpatient care, respectively. The overall mean rate of weight gain was 10.5(± 3.45) g/kg/day, and mean length of stay was 44.15(± 8.77) days. The recovery rate of children whose mothers travel less than 2 h to the health institution was about three times (AHR, 2.91; 95% CI (2.18, 3.88)) higher than children whose mothers travel 2 h and above. Compared with children who received vitamin A supplementation, children who lack supplementation were less likely (AHR, 0.39; 95% CI (0.25, 0.59)) to be cured. Moreover, the rate of recovery from outpatient therapeutic program among children who received antibiotics was about 1.4 times (AHR, 1.38; 95% CI (1.01, 1.89)) higher compared with children who did not receive of antibiotics. Conclusion This study showed that nearly eight children in every ten had recovered from severe acute malnutrition. Therefore, considering the distance of health facility from children’s residence, improving vitamin A supplementation and antibiotics are vital in improving the rate of recovery. Further research is also required to identify and address barriers to the provision of antibiotics and vitamin A supplementation.

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