Community-Based Management of Severe and Moderate Acute Malnutrition during Emergencies in Sri Lanka: Challenges of Implementation

Jayatissa, Renuka; Bekele, Aberra; Kethiswaran, A.; Silva, A. H. de

doi:10.1177/156482651203300405

Cited by 22 publications

(38 citation statements)

References 3 publications

(3 reference statements)

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“…the Democratic Republic of Congo (DRC), and some IDPs had experienced multiple displacements. 46,47 Intervention duration ranged from one week to five years, with a median of three months. Most studies were done in camps or clinical settings used by IDPs, and sometimes included IDPs within neighbouring communities.…”

Section: Study Characteristicsmentioning

confidence: 99%

Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

Ekezie

Adaji

Murray

2020

Health Promot Perspect

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Background: Conflict and violent crises have resulted in over 40 million of internally displaced persons (IDPs). Most affected regions lack access to basic health resources and generally rely on humanitarian support. The objective of this review was to appraise primary health service interventions among conflict-induced internally displaced populations in low and middle income countries between 2000 and 2019. Methods: A systematic review of literature in the following databases: Embase, MEDLINE, PsyArticles, PsycINFO, Scopus, Web of Science, LILAC and CAB Articles, was performed to identify interventions implemented in conflict IDP settings. Results: Initial searches yielded 4578 papers and 30 studies met the inclusion criteria. Descriptivesynthesis analysis was used, and the final selections were assessed using a customized CriticalAppraisal Skills Programme (CASP) checklist. Included papers were from Sub-Saharan Africa, South Asia and the Middle East regions. Most studies were on prevention interventions, especially water treatment and maternal health. Treatment interventions mostly focused on onmalaria and mental health. Only one food and nutrition study with outcome data was identified, indicating limitations in IDP health-related intervention publications. Reported interventions were conducted between one week to five years, and the study qualities were moderate. The most effective interventions were integrated programmes and common challenges were weakstudy methodology and data reporting. Conclusion: Regardless of the intervention types and durations, the services offered were beneficial to the IDPs. More intervention evidence are, however required as shown in gaps around food and nutrition, health education and disease surveillance.

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Section: Study Characteristicsmentioning

confidence: 99%

Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

Ekezie

Adaji

Murray

2020

Health Promot Perspect

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“…Strong community health platforms may strengthen resilience, or the ability to recover and speed to recovery after onset of manmade or natural emergency [4]. There are a small number of documented experiences of community health services being delivered during emergencies [5-7], but limited detail is provided on how services were delivered, how the emergencies impacted service delivery, or on the effectiveness of the services.…”

mentioning

confidence: 99%

The resilience of integrated community case management in acute emergency: a case study from Unity State, South Sudan

Kozuki¹,

Ericson²,

Marron³

et al. 2018

Journal of Global Health

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BackgroundAn active conflict in South Sudan in late 2013/early 2014 displaced approximately 2 million people over the course of several months. In May 2015, the International Rescue Committee and UNICEF conducted a mixed-methods case study of the impact of that acute emergency on integrated community case management (iCCM) of childhood illness programming in Payinjiar County, Unity State. The objective was to document the operations of an iCCM program during an acute crisis and to assess the program’s ability to continue operations.ResultsThis mixed-methods case study is comprised of semi-structured interviews and focus groups with key stakeholders such as policymakers, program implementers, community health workers (CHWs), and caregivers on their experience with iCCM programming during this time period. Routine program data were also analyzed to assess the effect of the crisis on key health indicators.FindingsInternally displaced persons (IDPs) nearly doubled the population in Payinjiar. Some displaced CHWs continued to provide treatment in host communities when they were able to take supplies with them. Despite no formal community mobilization effort by the iCCM program, many IDPs identified CHWs in the communities they were displaced to and obtained care from them. Caregivers who had been internally displaced reported preferring care from CHWs especially in contrast to risking an insecure journey to health facilities. The total number of treatments provided per month by CHWs dropped during the acute crisis, but recovered to pre-crisis levels within six months. CHW supervisors attempted to continue supervision by utilizing their networks to track down displaced CHWs and assess the security situation prior to visits. The monthly supervision rate dropped to the lowest level of 77% in February 2014, but rebounded to 91% by August 2014. Several CHWs and community leaders qualitatively validated this claim of sustained supervision.ConclusionsCHWs, including those who were internally displaced, continued to provide treatment for childhood illnesses during an acute emergency, and service provision recovered faster to pre-crisis levels than the formal health sector. International donors and humanitarian actors should recognize iCCM as a potentially high-impact humanitarian response. Flexible funding from donors would enable further evidence generation on iCCM approaches and improvements that could both sustain and enhance programming in acute crisis.

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“…However, recovery rates were defined differently in each study: Nielsen used MUAC >130 mm, Vautier used >85% WFH, James used 15% weight gain or MUAC >110 mm and Amthor used WFH >100% reference standard. Improvements in WFH and WFA measurements were seen in studies examining supplementary and therapeutic combination feeding programmes . Stefanak et al .…”

Section: Resultsmentioning

confidence: 99%

“…While many studies used WHO 2006 reference standards to define moderate and severe stunting and wasting (labelled ‘WHO’ in Table ), others used the National Center for Health Statistics (NCHS)/WHO international growth reference standards (labelled NCHS in Table ) . Wasting (WFH) was used as an outcome in 15 studies , stunting (HFA) in five studies , underweight (WFA) in five studies and MUAC in five studies . Four studies described weight gain and one described linear growth .…”

Section: Resultsmentioning

confidence: 99%

“…While studies describing anthropological markers typically utilised 2006 WHO definitions of moderate and severe stunting and wasting, some studies used the National Center for Health Statistics (NCHS)/WHO international growth reference from 1977 . Perhaps more importantly, studies differed in their definition of what constituted ‘recovery’ from malnutrition . While similar definitions of anaemia were used, some studies assessed ‘any’ anaemia and some examined severe, moderate and mild anaemia, with a subset of authors stratifying by age .…”

Section: Discussionmentioning

confidence: 99%

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Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review

Balhara

Silvestri

Winders

et al. 2017

Tropical Med Int Health

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Abstractobjectives Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition.methods A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18 years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.results A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High-and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers.conclusion In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed.

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Community-Based Management of Severe and Moderate Acute Malnutrition during Emergencies in Sri Lanka: Challenges of Implementation

Cited by 22 publications

References 3 publications

Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

Essential healthcare services provided to conflict-affected internallydisplaced populations in low and middle-income countries: A systematicreview

The resilience of integrated community case management in acute emergency: a case study from Unity State, South Sudan

Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review

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