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An integrated community-based outpatient therapeutic feeding programme for severe acute malnutrition in rural Southern Ethiopia: Recovery, fatality, and nutritional status after discharge.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell barnhälsa och nutrition)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell barnhälsa och nutrition)
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
(Internationell sexuell och reproduktiv hälsa/Larsson)
2017 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709Article in journal (Refereed) Epub ahead of print
Abstract [en]

A scaled up and integrated outpatient therapeutic feeding programme (OTP) brings the treatment of severely malnourished children closer to the community. This study assessed recovery from severe acute malnutrition (SAM), fatality, and acute malnutrition up to 14 weeks after admission to a programme integrated in the primary health care system. In this cohort study, 1,048 children admitted to 94 OTPs in Southern Ethiopia were followed for 14 weeks. Independent anthropometric measurements and information on treatment outcome were collected at four home visits. Only 32.7% (248/759) of children with SAM on admission fulfilled the programme recovery criteria at the time of discharge (i.e., gained 15% in weight, or oedema, if present at admission, was resolved at discharge). Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely malnourished, and 37.5% (348/928) were moderately malnourished; thus, 72.1% were acutely malnourished. Of the children, 27/982 (2.7%) had died by 14 weeks, of whom all but one had SAM on admission. Children with severe oedema on admission had the highest fatality rate (12.0%, 9/75). The median length of admission to the programme was 6.6 weeks (interquartile range: 5.3, 8.4 weeks). Despite children participating for the recommended duration of the programme, many children with SAM were discharged still acutely malnourished and without reaching programme criteria for recovery. For better outcome of OTP, constraints in service provision by the health system as well as challenges of service utilization by the beneficiaries should be identified and addressed.

Place, publisher, year, edition, pages
2017.
Keywords [en]
Ethiopia, integrated outpatient therapeutic programme, outcome, recovery, severe acute child malnutrition
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-331991DOI: 10.1111/mcn.12519ISI: 000428452800006PubMedID: 29024381OAI: oai:DiVA.org:uu-331991DiVA, id: diva2:1150970
Funder
Sida - Swedish International Development Cooperation Agency, SWE-2010-179Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2018-06-05Bibliographically approved
In thesis
1. Identification and Community Management of Severe Acute Malnutrition: Empirical evidence in rural Southern Ethiopia
Open this publication in new window or tab >>Identification and Community Management of Severe Acute Malnutrition: Empirical evidence in rural Southern Ethiopia
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The current recommended standard management for all children with severe acute malnutrition (SAM) is Community-based Management of Acute Malnutrition (CMAM). CMAM has a community-based outpatient therapeutic program (OTP) to treat uncomplicated SAM and has been scaled-up and integrated with government health services in low-resource settings. How-ever, the context in which such large-scale programs are implemented modifies their effective-ness. This study aims at assessing factors of importance for the effectiveness of management of SAM in the community.

A population-based survey of households with children aged under five years and a longitu-dinal study among children admitted to the integrated OTPs of rural Southern Ethiopia was undertaken. For Study I, children aged 6-59 months (n=4,297) from randomly selected house-holds were examined for differences between children identified as SAM by MUAC and WHZ. For Study II, subsets of 1,048 children admitted to OTPs were analyzed for program outcome and nutritional status at discharge (n=759) and 14 weeks after admission (n=991). For Study III, non-oedematous children (n=661) admitted to OTPs were analyzed for gains in anthropo-metric measures after 4 weeks of treatment. For Study IV, children with SAM (n=788) were studied in terms of factors of importance for their recovery. Home-visits were used to collect data and anthropometry was measured following standardized World Health Organization (WHO) techniques.

The degree of agreement between the two anthropometric indicators of severe wasting dif-fered depending on the sex and age of the children. The indicators’ response to treatment varied according to the indicator used to define SAM at admission. While 32.7% achieved the program’s recovery criteria at discharge, 29.6% had SAM at discharge and 72.1% of children were acutely malnourished at the end of 14 weeks of follow-up. Despite low recovery rate, children of caregivers with the highest decision-making autonomy recovered faster from SAM than children of caregivers with lower autonomy.

The poor agreement between MUAC and WHZ in diagnosing SAM within different groups of children indicates each anthropometric indicator may select different set of children for treatment. Our study provided empirical evidence that supports the current recommendation to use MUAC and WHZ independently for the management of SAM. Linking CMAM to other com-plementary programmes may improve the effectiveness of integrated large-scale nutrition programmes.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 60
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1457
Keywords
Severe acute malnutrition, children, anthropometric indicators, integrated outpatient therapeutic programme, recovery, Ethiopia
National Category
Medical and Health Sciences
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-347845 (URN)978-91-513-0316-1 (ISBN)
Public defence
2018-05-29, Rosénsalen, Ing 95/96, Akademiska sjukhuset, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2018-05-08 Created: 2018-04-08 Last updated: 2018-05-08

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