Background The Community-Based Management of Acute Malnutrition (CMAM) model transformed the treatment of severe acute malnutrition (SAM) by shifting treatment from inpatient facilities to the community. Evidence shows that while CMAM programs are effective in the initial recovery from SAM, recovery is not sustained for some children requiring them to receive treatment repeatedly. This indicates a potential gap in the model, yet little evidence is available on the incidence of relapse, the determinants of the phenomena, or its financial implications on program delivery. Methods This study is a multi-country prospective cohort study following “post-SAM” children (defined as children following anthropometric recovery from SAM through treatment in CMAM) and matched community controls (defined as children not previously experiencing acute malnutrition (AM)) monthly for six months. The aim is to assess the burden and determinants of relapse to SAM. This study design enables the quantification of relapse among post-SAM children, but also to determine the relative risk for, and excess burden of, AM between post-SAM children and their matched community controls. Individual -, household-, and community-level information will be analyzed to identify potential risk-factors for relapse, with a focus on associations between water, sanitation, and hygiene (WASH) related exposures, and post-discharge outcomes. The study combines a microbiological assessment of post-SAM children’s drinking water, food, stool via rectal swabs, dried blood spots (DBS), and assess for indicators of enteric pathogens and immune function, to explore different exposures and potential associations with treatment and post-treatment outcomes. Discussion This study is the first of its kind to systematically track children after recovery from SAM in CMAM programs using uniform methods across multiple countries. The design allows the use of results to: 1) facilitate understandings of the burden of relapse; 2) identify risk factors for relapse and 3) elucidate financial costs associated with relapse in CMAM programs. This protocol’s publication aims to support similar studies and evaluations of CMAM programs and provides opportunities for comparability of an evidence-based set of indicators for relapse to SAM.
From childhood to adulthood, adolescence phase transition, implies many lifestyle changes. This study aims to investigate the perception of adolescent girls of their own diet and health status. A cross-sectional study, using a structured face-to-face administered questionnaire, were carried out in 395 adolescent girls 15 - 19 years old in secondary schools in Cotonou, in Benin. Chi 2 and Wilcoxon - Mann Whitney tests were performed to appreciate the variables associations. Logistic regression was executed to appraise the effect of self-perception on dietary practices. The average age of the participants was 16.7 ± 1.26 years. The prevalence of self-reported anaemia, diet quality and overweight/obesity was 18.23%; 57.72% and 9.87% respectively. Considering school character, more adolescents in private schools perceived themselves as being “overweight/obese” (22.8%) compared to their peers from public schools (0.4%). Self-perceived anaemia was related to dark green leafy vegetable and vitamin C-rich fruits consumption while self-perceived overweight/obesity decrease the consumption of meat and meat products. Adolescents who perceived their own diet as healthy reached the Minimum Dietary Diversity. The findings of this study highlight the importance of self-perception in adolescents eating habits and this should be considered in interventions improving their diet quality.
Adolescence is a period between childhood and adulthood with eating habits often against the nutritional needs of adolescents. The present study used a socio-ecological approach to investigate personal and environmental factors influencing the eating habits of 15-to 19-years old Beninese urban schoolgirls. Eleven focus groups (n = 77) and seven individual interviews were conducted with adolescent girls attending school in Cotonou, Benin. Focus groups were as homogeneous as possible regarding age group and school character. Transcripts were analyzed using an inductive-deductive thematic method using the socio-ecological model. Taste preference for sweet foods, insufficient dietary knowledge and low personal income were factors explaining unhealthy food choices, while higher self-efficacy and healthy outcome expectations mainly characterized their healthy eating habits at the intrapersonal level. Family influence was beneficial for healthy eating while friends’ pressure led to an unhealthy diet at the interpersonal level. At the organizational level, adolescents reported unhealthy school food environments and urban areas increased their unhealthy eating habits. It appears that one factor alone is not enough to influence adolescent girls’ eating habits. Therefore, this study presents the need of elaborating interventions in a school context to improve eating habits in adolescents focusing on different factors in Beninese adolescent schoolgirls.
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