The Promise of a Community-Based Approach to Managing Severe Malnutrition: A Case Study from Ethiopia

Chaiken, Miriam S.; Deconinck, Hedwig; Degefie, Tedbabe

doi:10.1177/156482650602700201

Cited by 26 publications

(41 citation statements)

References 8 publications

(8 reference statements)

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“…One of the measures taken by the Zambian Government to reduce mortality due to severe malnutrition was to implement the Outpatient Therapeutic Programme (OTP). OTP is considered to be an innovation for treating SAM in children 6 to 59 months of age, with no medical complications as outpatients within their communities, using ready-touse therapeutic food (RUTF) and child care treatment [8][9][10]. The OTP intervention in Eastern Zambia was first pilot tested as a community-based therapeutic care (CTC) [7] in February 2008, and a full implementation begun in August 2008 [11].…”

Section: Introductionmentioning

confidence: 99%

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

2016

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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.

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Section: Introductionmentioning

confidence: 99%

“…In the OTP, children receive daily ratio of RUTF, antibiotics, Vitamin A, Folic acid, Anthelminthic and Antimalarial drugs [1,12]. The OTP programme has been implemented in other poor resourced countries such as Niger, North and South Sudan, Malawi, Chad and Ethiopia [5,8,10,12,13].…”

Section: Introductionmentioning

confidence: 99%

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

2016

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“…It had opened many TFCs for assisting drought victims [19]. However, after about five months of operation high number of case loads, the need to reach more cases with otherwise limited capacity of the centers to care for more children and the potential for disease outbreaks in the centers and the Regional Health Bureau's concerns on the increasing number of TFC prompted SC/USA to pilot CTC in three woredas of SNNPR [20,21]. …”

Section: Introductionmentioning

confidence: 99%

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Tekeste

Wondafrash

Azene

et al. 2012

Cost Eff Resour Alloc

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BackgroundThis study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition (SAM) in Sidama Zone, Ethiopia compared to facility based therapeutic feeding center (TFC).MethodsA cost effectiveness analysis comparing costs and outcomes of two treatment programmes was conducted. The societal perspective, which considers costs to all sectors of the society, was employed. Outcomes and health service costs of CTC and TFC were obtained from Save the Children USA (SC/USA) CTC and TFC programme, government health services and UNICEF(in kind supplies) cost estimates of unit costs. Parental costs were estimated through interviewing 306 caretakers. Cost categories were compared and a single cost effectiveness ratio of costs to treat a child with SAM in each program (regardless of outcome) was computed and compared.ResultsA total of 328 patient cards/records of children treated in the programs were reviewed; out of which 306 (157 CTC and 149 TFC) were traced back to their households to interview their caretakers. The cure rate in TFC was 95.36% compared to 94.30% in CTC. The death rate in TFC was 0% and in CTC 1.2%. The mean cost per child treated was $284.56 in TFC and $134.88 in CTC. The institutional cost per child treated was $262.62 in TFC and $128.58 in CTC. Out of these institutional costs in TFC 46.6% was personnel cost. In contrast, majority (43.2%) of the institutional costs in CTC went to ready to use therapeutic food (RUTF). The opportunity cost per caretaker in the TFC was $21.01 whereas it was $5.87 in CTC. The result of this study shows that community based CTC was two times more cost effective than TFC.ConclusionCTC was found to be relatively more cost effective than TFC in this setting. This indicates that CTC is a viable approach on just economic grounds in addition to other benefits such improved access, sustainability and appropriateness documented elsewhere. If costs of RUTF can be reduced such as through local production the CTC costs per child can be further reduced as RUTF constitutes the highest cost in these study settings.

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“…At the same time, income-poor populations do not have access to nutrient-rich food and sometimes become dependant recipients of aid based on special products (ready-to-use-food, RUF) instead of support to make optimal use of their own resources (Chaiken et al, 2006;UNICEF, 2014).…”

Section: Diets Food Nutrientsmentioning

confidence: 99%

Global Healthy Diet Approach to Nutrition

Krawinkel¹

2014

Development

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The world faces a double challenge in human nutrition: meeting energy and nutrient requirements to overcome and prevent undernutrition, and achieving a diet that helps to prevent caloric overnutrition. These goals can be achieved using bioactive plant compounds from vegetables and fruits, which are usually available locally when food sovereignty is respected.The world faces multiple challenges to nutrition, from hunger and undernutrition, nutrient deficiencies, and disease-related malnutrition on one end to caloric overnutrition leading to overweight and obesity on the other end (Keding et al., 2013;Steyn and McHiza, 2014). In fact, these ends are not far from each other but rather two sides of the same coin and -perhaps unexpectedly -they occur in developing, 'emerging' and industrialized countries, at the national, regional, community and family level.Before a healthy diet can be considered, nutrition security is a prerequisite. As illustrated in Figure 1, there are preconditions in the fields of agriculture and food systems, care and health. All of these together facilitate nutrition security and are the basis for a healthy diet. As many contributions to this issue of the journal illustrate, nutrition security demands primarily political and economic answers: poverty, land rights, gender equality, market access as well as other social and cultural issues. Still, a nutritional perspective keeping in mind human requirements can contribute to identifying appropriate solutions to nutrition challenges. Diets, food, nutrientsFundamental to a healthy diet is the safe provision of all nutrients, water and energy. This is usually addressed when food plants and animal-derived foods are considered as the basis for human diets. A somewhat misleading nutritional science has taken the attention away from diets and focused on macro-and micro-nutrients only. This has shifted policies and interventions more towards supplementation and fortification (or biofortification) of micronutrients and food energy and away from sustainable food systems (Müller and Krawinkel, 2005;Flynn et al., 2009). In the field of development cooperation, diets based on the nutritional value of natural foods are often neglected,

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The Promise of a Community-Based Approach to Managing Severe Malnutrition: A Case Study from Ethiopia

Cited by 26 publications

References 8 publications

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

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

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Global Healthy Diet Approach to Nutrition

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