Evaluation of outpatient therapeutic programme for management of severe acute malnutrition in three districts of the eastern province, Zambia

Abstract

Background: Severe acute malnutrition (SAM) in children under 5 years of age is a major cause of child mortality during hospital admission worldwide, and is attributed to poor case management. The Outpatient Therapeutic Programme (OTP) is an innovation for treating children with SAM with no medical complications as outpatients within their communities. The aim of the study was to evaluate the improvement in health outcomes and case fatality rate in children aged 6-59 months diagnosed with SAM and admitted in OTP centres, and to document the barriers to a sustainable OTP intervention in the districts of Eastern Zambia. Methods: A mixed-methods design was used to assess the health outcomes of OTP intervention. Three districts where OTP centres were operational at the time of study were selected. Records of 390 eligible children admitted with SAM between 2008 and 2010 were reviewed. The health outcomes assessed included recovery and case fatality rates, defaulter rate, and weight gain. Information on the barriers to effective implementation of a sustainable OTP intervention in the districts was collected through semi-structured key-informant interviews with stakeholders. Outcome indicators were compared with the baseline data and recommended minimum standards for therapeutic feeding centres.

Cure rate and associated factors for children 6–59 months with severe acute malnutrition under the out patient therapeutic care programme in the health centres of Kabale District in Southwestern Uganda: a cross sectional study

“…The findings showed a cure rate of 36.3% very low compared to both the national (IMAM) and international (Sphere) standards that recommend a Cure rate of greater than 75% hence in an alarming state. The findings further indicated a lower Cure rate than in similar studies done in Ethiopia, Pakistani and Zambia (Teshom et al, [9], Eleanor et al, [7], Atnafe et al, [5] and Mwanza et al, [15]). This relates to findings by Zebenay and colleagues who found a low recovery rates in a similar programme in Ethiopia and suggested non adherence to treatment guidelines by the caretakers, sharing food at home, high burden of comorbidities as well as inappropriate feeding with RUTF as the likely causes.…”

The Pattern of Prevalence of Severe and Moderate Acute Malnutrition among Under-Five Children of Three Counties in a War-Torn Lakes State South Sudan

“…A total of 36 months data for SAM and MAM prevalence were extracted from the District Health Information Software (DHIS), for each of the three counties, across the three years-2014, 2015 and 2016. The possible reasons for these significant differences, in conjunction with rising median values of SAM prevalence (poor outcome) across the three counties, were as suggested by the report of a similar study (Mwanza et al, 2016) for SAM cases of under-five children, in three districts of eastern province in Zambia. These include; dependence on donor-funds for feeding, and consistent stock outs of food provision by humanitarian organizations, both of which are applicable in the three counties under this study.…”

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“…The possible reasons for these significant differences, in conjunction with rising median values of SAM prevalence (poor outcome) across the three counties, were as suggested by the report of a similar study (Mwanza et al, 2016) for SAM cases of under-five children, in three districts of eastern province in Zambia. These include; dependence on donor-funds for feeding, and consistent stock outs of food provision by humanitarian organizations, both of which are applicable in the three counties under this study.…”