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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. However, the context in which such large-scale programs are implemented modifies their effectiveness. 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 longitudinal 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 households 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 anthropometric 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 differed 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 complementary programs may improve the effectiveness of integrated large-scale nutrition programs................................................................
Dissertation available at ACIPH Library |
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