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Community based outpatient therapeutic 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). Addis Continental Institute of Public Health (ACIPH), 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). Addis Continental Institute of Public Health (ACIPH), Ethiopia.
Addis Continental Institute of Public Health (ACIPH), 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).
(English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203Article in journal, News item (Refereed) Submitted
Abstract [en]

Background: A scaled up and integrated outpatient therapeutic program (OTP) brings the treatment of severely malnourished children closer to the community. However, studies documenting program outcome and nutritional status beyond discharge from OTP are scarce. This study evaluated recovery from severe acute malnutrition (SAM), fatality and nutritional status up to 14 weeks after admission to the programme.

Methods: In this cohort study, 1048 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.

Results: On admission 78.8% (826/1048) of the children had severe acute malnutrition. The mean length of admission to the programme was 7.1 weeks [95% CI 6.9 -7.3]. Only 37.8% (216/571) of children with SAM on admission fulfilled the programme recovery criteria (gained 15% in weight or oedema resolved, if present on admission) at discharge. However, of the children who achieved programme recovery criteria at discharge, 57.6% (121/210) were still acutely malnourished. Of all children admitted to the programme for whom nutritional assessment was done 14 weeks later, 34.6% (321/928) were severely and 34.4% (348/928) were moderately malnourished, thus 69.0% were acutely malnourished. A total of 27/982 (2.7%) of the children 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).

Conclusion: Despite children participating for the recommended duration of the programme, many were discharged without reaching programme criteria for recovery and acute malnutrition remained prevalent beyond discharge. Further research is needed to understand the factors constraining community management of acute malnutrition. 

National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-291455OAI: oai:DiVA.org:uu-291455DiVA: diva2:925628
Available from: 2016-05-02 Created: 2016-05-02 Last updated: 2016-06-22Bibliographically 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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