These results demonstrate that hygiene practices and livestock water management are correlated with acute malnutrition in Sila, Chad. These findings provide a hypothesis for a possible pathogen driving acute malnutrition rates- Cryptosporidium-as part of a complex water chain, whereby the source of infection may be mitigated by hygiene behaviors with important implications for humanitarian programs.
Few studies have examined the effect on health and nutrition outcomes of food offered “by prescription” to people living with HIV/AIDS. Likewise, the implementation processes conducive to achieving significant impacts and constraints to program effectiveness are not well documented. This study examines the delivery and utilization of a therapeutic Plumpy'nut ration as part of the Ethiopia National Food by Prescription (FBP) Program. Quantitative monitoring data from FBP clinic sites were analyzed to examine the proportion of patients attending ART and FBP appointments and receiving drugs and nutrition rations. 130 male and female FBP participants and medical staff were engaged in focus group discussions using participatory methods at 8 FBP program health facilities to examine factors related to program participation, adherence, and perceived changes in health and nutrition status. Approximately 50% of rations were reportedly consumed by the HIV+ index patient. Pressure to sell and share rations, negative ration side‐effects, transportation difficulties, stigma, and additional burden on health workers emerged as constraints to efficient implementation. Attention to often under‐utilized monitoring data can enable the timely resolution of critical implementation bottlenecks, leading to greater program effectiveness.
Objectiveassess marginal cost and cost‐effectiveness of adding a nutritional supplement to standard treatment of wasted HIV+ patients to raise BMI.MethodsSupplement was provided in 8 clinics; 8 non‐randomly assigned comparison clinics provided standard care: ART, counseling. Costs included: supplement, staff time; administrative cost. Patients’ time in clinic visits was tracked.ResultsRecovery was defined as BMI=18.5 for 2 visits. Treatment patients spent more time per visit. Marginal cost per recovered patient was $12,192 for those entering with severe acute malnutrition (SAM=BMI<= 16) and $1980 for those with moderate acute malnutrition (MAM=BMI >; 16 < 18.5) due to low recovery in SAM patients. Default (failure to complete treatment) was high (70.6% treatment; 59.6% comparison). Three models assessed potential effects of reducing default. Reducing default substantially increased recovery rates and reduced marginal cost per recovered patient; costs were much lower for patients entering as MAM than SAM.ConclusionsSupplementation of wasted HIV+ patients should start early for maximum cost‐effectiveness; reducing default greatly increases cost‐effectiveness.No conflict of interest.
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