Key Issues in the Success of Community-Based Management of Severe Malnutrition

Collins, Steve; Sadler, Kate; Dent, Nicky; Khara, Tanya; Guerrero, Saúl; Myatt, Mark; Saboya, Montse; Walsh, Allyn

doi:10.1177/15648265060273s304

Cited by 176 publications

(182 citation statements)

References 29 publications

(26 reference statements)

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“…Although it is unanimously recognised that undernutrition, including SAM, contributes directly and indirectly to a high proportion of deaths of under-five children, debate that started in the early seventies on whether it is worth investing in the treatment of SAM particularly in the community based management of SAM, continues Black et al, 2008;Cook, 1971;Roosmalen-Wiebenga et al, 1987). This is despite the fact that most countries and NGOs that have adopted the CTC approach have been able to reduce the case fatality rate to levels lower than 10%, with some programmes reporting case fatality rates of lower than 5% (Bezanson and Isenman, 2010;Collins et al, 2006b). Studies have also reported very low relapse rates (Bahwere et al, 2008;Khanum et al, 1998).…”

Section: Bahwere Et Al 221mentioning

confidence: 82%

“…The paper demonstrated that SAM is one of the major contributors to under-five mortality for which costeffective interventions exist (Collins et al, 2006a). The introduction of CTC has recently further improved this cost-effectiveness (Collins et al, 2006b, WHO et al, 2007. CTC allows a reduction of the institutional and caretakers' opportunity costs, and increases coverage and improves the outcomes for children.…”

Section: Introductionmentioning

confidence: 99%

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Long term mortality after community and facility based treatment of severe acute malnutrition: Analysis of data from Bangladesh, Kenya, Malawi and Niger

Bahwere¹

2012

J. Public Health Epidemiol.

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The effectiveness of the community based therapeutic care (CTC) in treating severe acute malnutrition (SAM) has been demonstrated. However, there is still resistance from some policy makers and donors to invest into this cost-effective intervention. The mortality rate ratio (MRR) calculated by dividing the observed deaths after discharge by expected deaths was used to compare survival of 1,670 children discharged from the Dowa CTC from August 2002 to May 2005 and that of other cohorts reporting on long term survival of children after treatment of SAM retrieved from literature. A MMR of 1.1 (0.9 to 1.4) was observed for the Dowa CTC cohort while the MMR of 2.7 (1.3 to 4.9), 5.5 (3.9 to 7.6) and 20.0 (11.0 to 33.4) were observed for studies retrieved from the literature. Data showed that the survival of children who defaulted was worse than that of those who were discharged cured, and that of children treated at home after stabilisation or directly was better than those treated as inpatient until exit from the programme. The study outlines the need of using MMR when reporting on long term survival after SAM treatment and suggests that CTC should be included in the package of interventions with high potential for accelerating the progress towards reaching Millennium Developmental Goal four.

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Section: Bahwere Et Al 221mentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Long term mortality after community and facility based treatment of severe acute malnutrition: Analysis of data from Bangladesh, Kenya, Malawi and Niger

Bahwere¹

2012

J. Public Health Epidemiol.

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“…1 Reliance on RUTF has a number of operational advantages: it reduces the logistic load for the end user, allows rapid roll-out and access to treatment, permits home-based ambulatory care and is cost-effective. 2,3 One of the most widely used RUTFs in Africa is Plumpy'nut ® (PPN; Nutriset, Malaunay, France; http:// www.nutriset.fr/en/product-range/produit-par-produit/ plumpynut-ready-to-use-therapeutic-food-rutf.html), which is a peanut-based mixture of milk powder, sugar, vegetable oil, minerals and vitamins. It does not require cooking or dilution with water, and is thus practical for use where such resources are limited.…”

Section: Interna Onal Union Against Tuberculosis and Lung Diseasementioning

confidence: 99%

Peanut-based ready-to-use therapeutic food: acceptability among malnourished children and community workers in Bangladesh

Ali

Zachariah

Dahmane

et al. 2013

public health action

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with a community-based nutrition programme that has been using PPN for the management of acute malnutrition among children in a slum setting in Dhaka, Bangladesh. Bangladesh has one of the highest prevalence rates of childhood malnutrition in the world: 6,7 almost 46% of children aged <5 years are stunted (low height for age) and 15% are wasted (low weight for height). 8 During the implementation of this nutrition programme, several care givers of children complained of diffi culties in feeding their children with PPN and attributed it to the taste and smell of PPN. The programme also faced challenges in terms of a high lossto-follow-up rate (15-17%) and relatively low nutritional recovery rates (59-65%) compared to those reported in the literature. 9 A relatively long average length of stay in the programme (60-63 days) has also been observed. We are concerned that these fi ndings might be related to the overall acceptability of PPN, which is a key determinant in ensuring favourable outcomes of nutritional rehabilitation. While some studies in Africa have shown that peanut-based RUTF has good acceptability and compliance among severely malnourished children, 10-12 other studies have demonstrated barriers to its use and inadequate compliance, mainly due to sharing within the households. 13,14 There is, however, limited published literature on PPN acceptability in South Asia.In the present study, we assessed the acceptability of PPN among 1) care givers of malnourished children and 2) community health workers (CHWs), in Kamrangirchar slum, Dhaka, Bangladesh. METHODS DesignThis was a cross-sectional semi-structured questionnaire survey. Study setting and study populationThe study was conducted between April and June 2011 in Kamrangirchar, an urban slum setting in Dhaka, Bangladesh, with about 400 000 inhabitants living in an area of 3.1 km 2 . It is not offi cially considered as part of Dhaka City, and all health services are outsourced to non-governmental organisations, who are the main providers.MSF started its nutrition programme for children in May 2010. All services are provided free of charge . It is to be noted that 47% of children needed encouragement or were forced to eat PPN, while 5% completely rejected it after 3 weeks. Of the 29 CHWs interviewed, 48% were dissatisfied with PPN's taste and consistency, and 55% with its smell. However, 91% of the care givers and all CHWs still perceived a therapeutic benefit of PPN for malnourished children. Conclusion: Despite a therapeutic benefit, only 4 in 10 care givers perceived PPN as being acceptable as a food product, which is of concern. Interna onal Union Against Tuberculosis and Lung Disease

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“…3 Such children require prompt medical management, as they are relatively more vulnerable to morbidity and mortality. 4 The WHO recommends the use of two independent anthropometric criteria to diagnose SAM among children aged 6 -59 months. These two criteria are mid-upper arm circumference (MUAC) ,115 mm and weight-for-height Z-score (WHZ) ,3.…”

Section: Introductionmentioning

confidence: 99%

Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh?

Ali

Zachariah

Shams³

et al. 2013

Transactions of the Royal Society of Tropical Medicine and Hygi

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Objectives: Mid-upper arm circumference (MUAC) and weight-for-height Z-score (WHZ) identify different populations of children with severe acute malnutrition (SAM) with only some degree of overlap. In an urban slum in Bangladesh, we conducted a prospective cohort study on children assessed as being severely malnourished by WHZ (,-3) but not by MUAC (.115 mm), to: 1. Assess their nutritional outcomes, and 2. Report on morbidity and mortality.Methods: Children underwent 2-weekly prospective follow-up home visits for 3 months and their anthropometric evolution, morbidity and mortality were monitored.Results: Of 158 children, 21 did not complete follow-up (six were lost to follow-up and 15 changed residence). Of the remaining 137 children, nine (7%) required admission to the nutrition programme because of: MUAC dropping to ,115 mm (5/9 children), weight loss ≥10% (1/9 children) and severe medical complications (3/9 children, of whom one died). Of the remaining 128 children who completed follow-up, 91 (66%) improved in nutritional status while 37 (27%) maintained a WHZ of ,-3. Cough was less frequent among those whose nutritional status improved.Conclusions: It seems acceptable to rely on MUAC as a single assessment tool for case finding and for admission of children with SAM to nutritional programmes.

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Key Issues in the Success of Community-Based Management of Severe Malnutrition

Cited by 176 publications

References 29 publications

Long term mortality after community and facility based treatment of severe acute malnutrition: Analysis of data from Bangladesh, Kenya, Malawi and Niger

Long term mortality after community and facility based treatment of severe acute malnutrition: Analysis of data from Bangladesh, Kenya, Malawi and Niger

Peanut-based ready-to-use therapeutic food: acceptability among malnourished children and community workers in Bangladesh

Is mid-upper arm circumference alone sufficient for deciding admission to a nutritional programme for childhood severe acute malnutrition in Bangladesh?

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