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Challenges in Implementing the Integrated Community-Based Outpatient Therapeutic Program for Severely Malnourished Children 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). 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.
2016 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 5, 251Article in journal (Refereed) Published
Abstract [en]

Currently, treatment of uncomplicated severe acute malnutrition is managed inthe integrated Community based Outpatient Therapeutic Program (C-OTP) using ready-to-usetherapeutic foods (RUTFs). The aim of this study was to determine challenges in implementingthe critical steps in C-OTP and caregivers’ perceptions of service provision in southern Ethiopia.A total of 1048 caregivers of children admitted to the OTP and 175 Health Extension Workers (HEWs)from 94 selected health posts were included in the study. Program admission, follow-up and exitinformation was collected from caregivers during home visits. HEWs were interviewed at theirrespective health posts. Only 46.6% (481/1032) were given the recommended amount of RUTF and19.3% (196/1015) were given antibiotics on admission. During C-OTP participation 34.9% (316/905)had uninterrupted provision of the recommended amount of RUTF. Of the children who left theprogram, 220/554 (39.7%) exited the program in line with the national recommendation. Caregivers(42.9% (394/918) and HEWs (37.1%, 62/167) perceive that RUTFs were being sold as a commodity.Inadequate provision and unintended usage of RUTFs, lack of antibiotics and inappropriate exitfrom the program were major constraints. For successful saving of lives, adequate resources must beallocated, and providers must be trained regularly, and supervised properly.

Place, publisher, year, edition, pages
2016. Vol. 8, no 5, 251
Keyword [en]
severe acute malnutrition; ready to use therapeutic foods; outpatient therapeutic program; integrated; Ethiopia
National Category
Medical and Health Sciences Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-291458DOI: 10.3390/nu8050251ISI: 000378780900012OAI: oai:DiVA.org:uu-291458DiVA: diva2:925637
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2016-05-02 Created: 2016-05-02 Last updated: 2017-11-30Bibliographically 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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