scholarly journals A quantitative cross-sectional survey of psychosocial stimulation and counselling interventions at nutritional rehabilitation units in Southern Malawi

2019 ◽  
Vol 31 (4) ◽  
pp. 238-243
Author(s):  
Allison I Daniel
Keyword(s):  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
World Health ◽  
Limited Information ◽  
Nutritional Rehabilitation ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Psychosocial Stimulation ◽  
Counselling Interventions

BackgroundInpatient treatment at nutritional rehabilitation units (NRUs) is needed for children who have severe acute malnutrition (SAM) and acute illness, loss of appetite, or severe oedema. World Health Organization guidelines state that nutritional counselling should be done with primary caregivers at NRUs. These recommendations also include psychosocial stimulation interventions to improve developmental outcomes in children with SAM. However, there is limited information about the delivery of these types of interventions for caregivers and children in NRU settings. The primary objective of this research was therefore to obtain data about NRU resources, activities, and protocols relevant to psychosocial stimulation and counselling interventions during inpatient treatment of children with SAM. MethodsA cross-sectional survey was administered by interview at all 16 NRUs in seven districts in Southern Malawi. Participants were health workers, nurses, and nutritionists employed at the respective NRUs. ResultsThe response rate was 100% across NRUs. Half of participants said that psychosocial stimulation interventions are conducted at their respective NRUs, yet none of the NRUs have protocols for delivery of these interventions. Furthermore, 7/16 (44%) NRUs have no resources for psychosocial stimulation including play materials. Thirteen of 16 (81%) participants said that they feel this type of intervention is very important and 3/16 (19%) participants said that this somewhat important for children with SAM. All NRUs provide counselling to caregivers about breastfeeding and nutrition; 15/16 (94%) also give counselling about water, sanitation and hygiene. ConclusionsUltimately, results from this survey highlighted that there is a need to invest in comprehensive interventions to improve developmental and nutritional outcomes in these vulnerable children requiring admission to NRUs. 

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>

Quality of Antenatal Care Services in a Developing Country: A Cross-Sectional Survey

2020 ◽  
Vol 26 (1) ◽  
pp. e25-e34
Author(s):  
Jacoline Sommer Albert ◽  
Ahtisham Younas ◽  
Gideon Victor
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Health Care Providers ◽  
Health Workers ◽  
World Health ◽  
Care Providers ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Health Organization

The global adult lifetime risk of maternal mortality is 1 in 180; in Pakistan, it is 1 in 170; in developed regions, 1 in 4,900 (Alkema et al., 2016; Filippi, Chou, Ronsmans, Graham, & Say, 2016; World Health Organization [WHO], 2015). The differences in maternal mortality between developed and developing countries are mainly due to the quality of antenatal care (ANC) available in the two groups of countries. The purpose of this study was to assess the structural and procedural quality of ANC services provided and to assess satisfaction levels of women receiving ANC services in two large hospitals in Islamabad, Pakistan. A cross-sectional survey was conducted at the hospitals' outpatient maternal and child health clinics, with a random sample of 138 women. The overall quality of ANC was rated as good (61%), average (17.5%), or poor (17.5%). The findings suggest a need to cultivate quality of care at public health facilities, train health workers in communication skills, and build technical capacity by continuing education and supportive supervision to train health-care providers to follow standard protocols for provision of quality ANC services.

scholarly journals Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan

2017 ◽  
Vol 21 (2) ◽  
pp. 385-390 ◽  
Author(s):  
Eleanor Rogers ◽  
Muhammad Ali ◽  
Shahid Fazal ◽  
Deepak Kumar ◽  
Saul Guerrero ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Supervision And Training ◽  
Mid Upper Arm Circumference ◽  
The Impact ◽  
Care Study

AbstractObjectiveTo assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community.DesignCross-sectional quality-of-care study.SettingThe feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model.SubjectsLHW implementing treatment for uncomplicated SAM in the community.ResultsOedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %.ConclusionsThis quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.

scholarly journals Missed Opportunities in Tuberculosis Investigation and Associated Factors at Public Health Facilities in Uganda 

2020 ◽  
Author(s):  
Keith Kakame ◽  
Noel Namuhani ◽  
Andrew Kazibwe ◽  
Felix Bongomin ◽  
Joseph Baluku ◽  
...  
Keyword(s):  
Public Health ◽  
Health Workers ◽  
Health Facilities ◽  
World Health ◽  
Cross Sectional Survey ◽  
Prevalence Survey ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Public Health Facilities ◽  
Factors Associated

Abstract BackgroundThe incidence of tuberculosis (TB) is high in Uganda; yet, TB case detection is low. A recent national TB prevalence survey revealed that only 16% of presumptive TB patients seeking care at health facilities were offered sputum microscopy or chest-X ray (CXR). The objective of this study was to determine the magnitude of, and patient factors associated with missed opportunities in TB investigation at public health facilities of Wakiso District in Uganda.MethodsA facility-based cross-sectional survey was conducted at 10 high volume public health facilities offering comprehensive TB services in Wakiso, Uganda, among adults (≥18 years) with at least one symptom suggestive of TB predefined according to World Health Organisation criteria. Using exit interviews, data on demographics, TB symptoms, and clinical data relevant to TB were collected. A missed opportunity in TB investigation was defined as a patient with symptoms suggestive of TB who did not have sputum and/or CXR evaluation to rule out TB. Poisson regression analysis was performed to determine factors associated with missed opportunities in TB investigation using STATA 14.ResultsTwo hundred forty seven presumptive TB patients were recruited into this study exiting at antiretroviral therapy (ART) clinics (n=132) or general outpatient clinics (n=115) at public health facilities. Majority of participants were females (161/247, 65.2%) and the mean +SD age was 35.1 + 11.5 years. Sputum and/or CXR were not requested from 138 (55.9%) patients with symptoms suggestive of TB disease. Patients who did not inform health workers about TB related symptoms were more likely to miss a TB investigation (adjusted prevalence ratio: 1.68, 95%CI; 1.36-2.08, P<0.001). Conclusion; A large proportion of patients with symptoms suggestive of TB did not have sputum and/ or CXR requested for investigation. Patients who did not inform health workers about their TB related symptoms were more likely to miss having sputum and/ or CXR requested. We recommend studies to explore barriers and facilitators of disclosure of TB symptoms to enable formulation of effective interventions to empower people to improve likelihood of disclosing TB related symptoms.

scholarly journals Modifying Intestinal Integrity and MicroBiome in Severe Malnutrition with Legume-Based Feeds (MIMBLE 2.0): protocol for a phase II refined feed and intervention trial

2018 ◽  
Vol 3 ◽  
pp. 95
Author(s):  
Kevin Walsh ◽  
Nuala Calder ◽  
Peter Olupot-Olupot ◽  
Tonny Ssenyondo ◽  
William Okiror ◽  
...  
Keyword(s):  
Lactose Intolerance ◽  
Severe Acute Malnutrition ◽  
Case Fatality ◽  
Acute Malnutrition ◽  
World Health ◽  
Severe Malnutrition ◽  
Epithelial Barrier ◽  
Nutritional Rehabilitation ◽  
Mucosal Integrity ◽  
Fermentable Carbohydrates

Background: Changes in intestinal mucosal integrity and gut microbial balance occur in severe acute malnutrition (SAM), resulting in treatment failure and adverse clinical outcomes (gram-negative sepsis, diarrhoea and high case-fatality). Transient lactose intolerance, due to loss of intestinal brush border lactase, also complicates SAM, thus milk based feeds may not be optimal for nutritional rehabilitation. Since the gut epithelial barrier can be supported by short chain fatty acids, derived from microbiota fermentation by particular fermentable carbohydrates, we postulated that an energy-dense nutritional feed comprising of legume-based fermentable carbohydrates, incorporated with lactose-free versions of standard World Health Organization (WHO) F75/F100 nutritional feeds will enhance epithelial barrier function in malnourished children, reduce and promote resolution of diarrhoea and improve overall outcome. Methods: We will investigate in an open-label trial in 160 Ugandan children with SAM, defined by mid-upper arm circumference <11.5cm and/or presence of kwashiorkor. Children will be randomised to a lactose-free, chickpea-enriched feed containing 2 kcal/ml, provided in quantities to match usual energy provision (experimental) or WHO standard treatment F75 (0.75 kcal/ml) and F100 (1 kcal/ml) feeds on a 1:1 basis, conducted at Mbale Regional Referral Hospital nutritional rehabilitation unit. The primary outcomes are change in MUAC at day 90 and survival to day 90. Secondary outcomes include: i) moderate to good weight gain (>5 g/kg/day), ii) de novo development of diarrhoea (>3 loose stools/day), iii) time to diarrhoea resolution (if >3 loose stools/day), and iv) time to oedema resolution (if kwashiorkor) and change in intestinal biomarkers (faecal calprotectin). Discussion: We hypothesize that, if introduced early in the management of malnutrition, such lactose-free, fermentable carbohydrate-based feeds, could safely and cheaply improve global outcome by reducing lactose intolerance-related diarrhoea, improving mucosal integrity and enhancing immunity, and limiting the risk of systemic infection and associated broad-spectrum antibiotic resistance. Registration: ISRCTN 10309022.

scholarly journals Missed opportunities in tuberculosis investigation and associated factors at public health facilities in Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Keith Twirire Kakame ◽  
Noel Namuhani ◽  
Andrew Kazibwe ◽  
Felix Bongomin ◽  
Joseph Baruch Baluku ◽  
...  
Keyword(s):  
Public Health ◽  
Health Workers ◽  
Prevalence Ratio ◽  
Health Facilities ◽  
World Health ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Public Health Facilities ◽  
Factors Associated

Abstract Background The incidence of tuberculosis (TB) is high in Uganda; yet, TB case detection is low. The population-based survey on the prevalence of TB in Uganda revealed that only 16% of presumptive TB patients seeking care at health facilities were offered sputum microscopy or chest-X ray (CXR). This study aimed to determine the magnitude of, and patient factors associated with missed opportunities in TB investigation at public health facilities of Wakiso District in Uganda. Methods A facility-based cross-sectional survey was conducted at 10 high volume public health facilities offering comprehensive TB services in Wakiso, Uganda, among adults (≥18 years) with at least one symptom suggestive of TB predefined according to the World Health Organisation criteria. Using exit interviews, data on demographics, TB symptoms, and clinical data relevant to TB diagnosis were collected. A missed opportunity in TB investigation was defined as a patient with symptoms suggestive of TB who did not have sputum and/or CXR evaluation to rule out TB. Poisson regression analysis was performed to determine factors associated with missed opportunities in TB investigation. Results Two hundred forty-seven (247) patients with presumptive TB exiting at antiretroviral therapy (ART) clinics (n = 132) or general outpatient clinics (n = 115) at public health facilities were recruited into this study. Majority of participants were female (161/247, 65.2%) with a mean + SD age of 35.1 + 11.5 years. Overall, 138 (55.9%) patients with symptoms suggestive of TB disease did not have sputum and/or CXR examinations. Patients who did not inform health workers about their TB related symptoms were more likely to miss a TB investigation (adjusted prevalence ratio (aPR): 1.68, 95%CI; 1.36–2.08, P < 0.001). However, patients who reported duration of cough of 2 weeks or more were less likely to be missed for TB screening (aPR; 0.69, 95%CI; 0.56–0.86, p < 0.001). Conclusion There are substantial missed opportunities for TB diagnosis in Wakiso District. While it is important that patients should be empowered to report symptoms, health workers need to proactively implement the WHO TB symptom screen tool and complete the subsequent steps in the TB diagnostic cascade.

scholarly journals Mid-upper arm circumference in detection of weight-for-height Z-score below −3 in children aged 6–59 months

2018 ◽  
Vol 21 (10) ◽  
pp. 1794-1799 ◽  
Author(s):  
Umesh Kapil ◽  
RM Pandey ◽  
Rahul Bansal ◽  
Bhavana Pant ◽  
Amit Mohan Varshney ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Characteristic Curve ◽  
Predictive Ability ◽  
Acute Malnutrition ◽  
Test Accuracy ◽  
Cross Sectional Survey ◽  
Upper Arm ◽  
Cross Sectional ◽  
Arm Circumference ◽  
Mid Upper Arm Circumference

AbstractObjectiveTo evaluate the predictive ability of mid-upper arm circumference (MUAC) for detecting severe wasting (weight-for-height Z-score (WHZ) <−3) among children aged 6–59 months.DesignCross-sectional survey.SettingRural Uttar Pradesh, India.SubjectsChildren (n 18 456) for whom both WHZ (n 18 463) and MUAC were available.ResultsThe diagnostic test accuracy of MUAC for severe wasting was excellent (area under receiver-operating characteristic curve = 0·933). Across the lower range of MUAC cut-offs (110–120 mm), specificity was excellent (99·1–99·9 %) but sensitivity was poor (13·4–37·2 %); with higher cut-offs (140–150 mm), sensitivity increased substantially (94·9–98·8 %) but at the expense of specificity (37·6–71·9 %). The optimal MUAC cut-off to detect severe wasting was 135 mm. Although the prevalence of severe wasting was constant at 2·2 %, the burden of severe acute malnutrition, defined as either severe wasting or low MUAC, increased from 2·46 to 17·26 % with cut-offs of <115 and <135 mm, respectively. An MUAC cut-off <115 mm preferentially selected children aged ≤12 months (OR=11·8; 95 % CI 8·4, 16·6) or ≤24 months (OR=23·4; 95 % CI 12·7, 43·4) and girls (OR=2·2; 95 % CI 1·6, 3·2).ConclusionsBased on important considerations for screening and case detection in the community, modification of the current WHO definition of severe acute malnutrition may not be warranted, especially in the Indian context.

scholarly journals Nutritional status of children in a remote village of desert region Tharparkar Sindh, Pakistan

2017 ◽  
Vol 1 (1) ◽  
pp. 9
Author(s):  
Fayza Rani
Keyword(s):  
Severe Acute Malnutrition ◽  
Living Conditions ◽  
Health Facilities ◽  
Acute Malnutrition ◽  
Severe Malnutrition ◽  
Cross Sectional Survey ◽  
Related Factors ◽  
Cross Sectional ◽  
Basic Health ◽  
Desert Region

Background and Introduction: An increasing number of deaths have accused at Tharparkar desert region of Sindh. Hence, a nutrition relief camp was set up at two remote villages named Haryar and Bhorilo. Visiting team consisted of nutritionists, dietitians, pediatricians and logistic support providers. Objective: To determine the prevalence of malnutrition among children (0-10 yrs) and its association with their living conditions. Methods: A cross sectional survey was conducted. Mothers with children aged 1 month to 10 years were invited to visit the camp.200 children were screened for malnutrition using anthropometric measurements including height, weight and Mid Upper Arm Circumference (MUAC). Dietary intake data was    collected from mother including information about feeding practices, vaccination, disease history, and living conditions. Data was analyzed through SPSS 17. Inc using descriptive statistics. Results: Out of 200 children, 191 questionnaires were     completed. Mean age was 3.6 ± 2.8 SD years. There were 101(52.9%) males and 90(47%) females. Results showed that 42.4 % (n=81) were affected by severe    malnutrition (lower than 3rd percentile). Children less than 5 years were severely wasted as per WHO diagnostic criteria for Severe Acute Malnutrition (SAM) as   indicated by 79(51%) children had a z score of -4 SD (for height & weight). Further analysis of children under 5 years into the mild acute (≤13.5 cm), moderate Acute (11.5-12.5 cm) and severe acute malnutrition (<11.5 cm) was carried out. The data demonstrated that 33.7 % (n=32) children had mild malnutrition, 37.7 % (n=58)  suffered from moderate malnutrition and 15 % (n=23) had severe malnutrition. Food intake includes roti (Pakistani bread) and chatni (green chilies paste). There was no consumption of fruit, vegetable and milk due to no availability. Infants were breast fed and vaccinated but inappropriate and delayed weaning practices were reported by the mothers. Nearest medical facility/hospital was located at a distance of 15-30 miles. Conclusion: Major non nutrition related factors found to be contributing towards malnutrition were lack of education, water scarcity, non-availability of food, drinking water and lack of basic health facilities. There should be a provision of basic health facilities at community level. Health education and nutrition counseling should be included in their basic health initiatives.

scholarly journals Prevalence of Tuberculosis among Children with Severe Acute Malnutrition at Ola during Children’s Hospital in Freetown Sierra Leone

2019 ◽  
pp. 1-7
Author(s):  
Lucy Eberechukwu Yaguo Ide
Keyword(s):  
Sierra Leone ◽  
Formal Education ◽  
Severe Acute Malnutrition ◽  
Childhood Mortality ◽  
Acute Malnutrition ◽  
World Health ◽  
Cross Sectional ◽  
Children's Hospital ◽  
Significant Difference ◽  
Children’S Hospital

Prevalence of Tuberculosis among Children with Severe Acute Malnutrition at Ola during Children’s Hospital in Freetown Sierra Leone. Worldwide, pediatric tuberculosis account for about 1million cases, annually, accounting for 10-15% of all tuberculosis; with more than 100,000 estimated mortality annually, it is also one of the 10 most common causes of childhood mortality. Aim of this study was to determine the prevalence of tuberculosis among children with severe acute malnutrition at Ola During Children’s Hospital in Freetown Sierra Leone. It was a descriptive cross-sectional study, carried out at the therapeutic feeding center (TFC) of Ola During Children’s Hospital in 2018. An opportunistic sampling method in which every next patient whose mother gave consent was recruited until the number 74 was reached. Patients who met the World Health Organisation (WHO) criteria for diagnosis of severe acute malnutrition were admitted into the TFC and consecutively selected and interviewed using a structured questionnaire after obtaining written informed consent, from their mothers or caregivers. All the mothers approached during the study period consented for the study. Diagnosis of tuberculosis was both clinically and by laboratory investigations, 74 children whose mothers/caregivers consented for the study were recruited. Data was entered into an excel spread sheet and analyzed using Epi info version 7. There were 74 children with a median age of 11 months ± 9.9SD. Forty (54.1%) Males and 34(45.9%) Females, with a M:F ratio of 1.18:1. Prevalence of tuberculosis was 20%. Diagnosis of Tuberculosis was based on clinical findings of extreme weight loss or failure to gain weight, Chest x-ray findings of perihilar infiltrates. Gene Xpert MTB RIF results were all negative 0(0%). Most of the mothers 59 (79.7%) were aged between 20-29 years, 45(60.9%) of them were petty traders, while 15(20.3%) had no formal education. The chi square was used to determine the statistical difference, there was no statistically significant difference between gender and TB, P= 0.3415, there is a statistically significant difference between no formal education and occurrence of tuberculosis in their children P= 0.0467. Conclusions/Recommendations: Prevalence of Tuberculosis is still high among children with severe acute malnutrition. Gene Xpert MTB RIF was unable to make a bacteriological confirmation. There are difficulties with making bacteriological confirmation of tuberculosis in resource poor settings. Guidelines requiring mainly clinical parameters need to be developed for use in resource limited countries.

scholarly journals Description of a community paediatric strategy offering a package of services to prevent malnutrition among children in one health district in Mali

2021 ◽  
Author(s):  
Thomas Roederer ◽  
Augusto E. Llosa ◽  
Susan Shepherd ◽  
Isabelle Defourny ◽  
Michel-Olivier Lacharité ◽  
...  
Keyword(s):  
One Health ◽  
Health Workers ◽  
Severe Acute Malnutrition ◽  
Scale Up ◽  
Health Indicators ◽  
Food Distribution ◽  
Acute Malnutrition ◽  
Cross Sectional ◽  
Health Area

AbstractBackgroundWe present results from an intervention case study, the Soins Preventifs de l’Enfant (SPE) project, in Konséguéla health area, Mali. The intervention involved a network of community health workers providing a comprehensive preventive/therapeutic package, ultimately aiming at reducing under 24-month mortality. Associated costs were documented to assess the feasibility of replication and scale-up.MethodsSPE program monitoring data were obtained from booklets specific to the program between 2010 and 2014. Data included sex, age, vaccination status, anthropometric measurements, Ready-To-Use-Supplementary Food distribution, morbidities reported by the mother between visits, hospitalizations over 18 months of follow-up. Cross-sectional surveys in the district of Koutiala, of which Konséguéla is one health area, were conducted yearly between 2010 and 2014 for comparison, using difference-in-difference approach. Ethical approval was granted from the Malian Ethical Committee.ResultsGlobal and Severe Acute Malnutrition prevalences decreased over time in Konséguéla as well as in the rest of the district, but the difference between areas was not significant. Children reaching 24 months were 20% less stunted in Konséguéla than children the same age outside (p<0.001). Mortality rates significantly decreased more in Konséguéla, while vaccination coverage for all antigens significantly increased in the meantime. The package cost approximately USD 95 per child per year; 56% of which was for the RUSF.ConclusionThe results of this case study suggest a sustained impact of a community based, comprehensive health package on major child health indicators. Most notably, while improvements in acute malnutrition were found in the district as a whole, those in the intervention area were more pronounced. Trends for other indicators suggest additional benefits.

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