uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Does caregivers’ autonomy influence recovery from Severe Acute Malnutrition in an integrated community-based outpatient Therapeutic Feeding Program?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Addis Continental Institute of Public Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
Addis Continental Institute of Public Health.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Caregivers’ autonomy is important for child nutritional status as it improves the availability of food and access to health resources necessary for children’s growth and recovery from illnesses. However, evidence on the extent of influence of caregivers’ autonomy during recovery from severe acute malnutrition (SAM) is limited. A cohort of children (n=788) aged 6-59 months admitted to community-based outpatient therapeutic programme (OTP) for SAM in rural southern Ethiopia were studied. Recovery from SAM was defined by MUAC ≥ 125 mm and absence of edema after treatment in OTP. A Kaplan Meier (KM) survival analysis was employed to estimate the recovery rates of the children treated for SAM for different level of caregivers’ autonomy and multivariable Cox proportional hazard regression analysis was used to control for confounding. Results from adjusted cox proportional hazard regression analysis indicated that children of caregivers with higher decision-making autonomy recovered more rapidly from SAM than children of caregivers with lower autonomy. Promotion of caregivers’ autonomy could augment effectiveness of a scaled up and integrated outpatient therapeutic feeding programme.

Keywords [en]
Caregivers’ autonomy, severe acute malnutrition, outpatient therapeutic programme recovery, children
National Category
Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-347807OAI: oai:DiVA.org:uu-347807DiVA, id: diva2:1195942
Projects
COMSAM
Funder
Sida - Swedish International Development Cooperation AgencyAvailable from: 2018-04-07 Created: 2018-04-07 Last updated: 2018-04-08
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: 2018-10-08

Open Access in DiVA

No full text in DiVA

By organisation
Department of Women's and Children's Health
Nutrition and Dietetics

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 19 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf