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Predicted implications of using percentage weight gain as single discharge criterion in management of acute malnutrition in rural southern Ethiopia
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). Institute of Tropical Medicine and International Health, Charité, Universitätsmedizin Berlin, Germany.
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). Addis Continental Institute of Public Health, Addis Ababa, Ethiopia. (Internationell sexuell och reproduktiv hälsa/Larsson)
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
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 sexuell och reproduktiv hälsa/Larsson)
2015 (English)In: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 11, no 4, 962-972 p.Article in journal (Refereed) Published
Abstract [en]

Mid-upper arm circumference (MUAC) is increasingly used in identifying and admitting children with acute malnutrition for treatment. It is easy to use because it does not involve height assessment, but its use calls for alternative discharge criteria. This study examined how use of percentage weight gain as discharge criterion would affect the nutritional status of children admitted into a community-based management programme for acute malnutrition in rural southern Ethiopia. Non-oedematous children (n = 631) aged 6-59 months and having a MUAC of <125 mm were studied. By simulation, 10%, 15% and 20% weight was added to admission weight and their nutritional status by weight-for-height z-score (WHZ) was determined at each target. Moderate and severe wasting according to World Health Organization WHZ definitions was used as outcome. Applying the most commonly recommended target of 15% weight gain resulted in 9% of children with admission MUAC <115 mm still being moderately or severely wasted at theoretical discharge. In children with admission MUAC 115-124 mm, 10% of weight gain was sufficient to generate a similar result. Children failing to recover were the ones with the poorest nutritional status at admission. Increasing the percentage weight gain targets in the two groups to 20% and 15%, respectively, would largely resolve wasting but likely lead to increased programme costs by keeping already recovered children in the programme. Further research is needed on appropriate discharge procedures in programmes using MUAC for screening and admission.

Place, publisher, year, edition, pages
2015. Vol. 11, no 4, 962-972 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-208312DOI: 10.1111/mcn.12076ISI: 000362197100042PubMedID: 23941395OAI: oai:DiVA.org:uu-208312DiVA: diva2:651894
Funder
Sida - Swedish International Development Cooperation Agency, SWE-2010-179
Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Integrated community-based management of severe acute child malnutrition: Studies from rural Southern Ethiopia
Open this publication in new window or tab >>Integrated community-based management of severe acute child malnutrition: Studies from rural Southern Ethiopia
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The World Health Organization (WHO) recommends the community-based Outpatient Therapeutic Program (OTP) as a standard treatment protocol for the management of uncomplicated Severe Acute Malnutrition (SAM) at the community level. OTP has been scaled up and integrated into the existing grassroots level government health systems in several developing countries. The aim of this thesis was to assess the implementation and outcome of a scaled-up and integrated OTP service provided at community level.

Methods: One qualitative study and three quantitative studies were conducted in southern Ethiopia. Children admitted to 94 integrated OTPs, their caregivers and health extension workers providing primary health care services in the nearby health posts were included in this study. The quantitative studies were based on data generated from observation of a cohort of 1,048 children admitted to the integrated OTPs.

Result: On admission 78.8% of the children had SAM. The majority of these children 60.2% exited the program neither achieving program recovery criteria nor being transferred to inpatient care. Fourteen weeks after admission to OTP, 34.6% were severely malnourished and 34.4% were moderately malnourished, thus 69.0% were still acutely malnourished. Ready-to-use Therapeutic Foods (RUTFs) provided for SAM children were commonly shared with other children in the household and sold as a commodity for the collective benefit of the family thus admitted children received only a portion of the provided amount. Further, the program suffered a severe shortage of RUTFs, where only  46.6% of admitted children were given the recommended amount of RUTFs by providers on admission and only 34.9% of these had uninterrupted provision during the follow-up.

Conclusion: The integrated OTPs we studied provide a constrained service and the use of RUTFs by families is not as intended by the program. The majority of admitted children remained acutely malnourished after participating in the program for the recommended duration. For integrated OTPs to be effective in chronically food-insecure contexts, interventions that also address the economic and food needs of the entire household are essential. This may require a shift to view SAM as a symptom of broader problems affecting a family rather than as a disease of an individual child. In addition, further research is needed to understand the health system context regarding RUTFs and medication supply and service utilization of integrated OTPs.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 62 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1232
Keyword
Severe acute malnutrition, integrated outpatient therapeutic programme, programme outcome, recovery, Ethiopia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-292781 (URN)978-91-554-9601-2 (ISBN)
Public defence
2016-08-26, Betty Petterssonsalen, Blåsenhus, von Kraemers allé 1, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2016-06-02 Created: 2016-05-09 Last updated: 2016-06-22

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Tadesse, ElazarEkström, Eva-Charlotte

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