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Perceptions of usage and unintended consequences of provision of ready-to-use therapeutic food for management of severe acute child malnutrition: A qualitative study in Southern Ethiopia
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell sexuell och reproduktiv hälsa/Larsson)
Department of Reproductive Health, Population and Nutrition, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity Studies, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell sexuell och reproduktiv hälsa/Larsson)
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2015 (English)In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 30, no 10, 1334-1341 p.Article in journal (Refereed) Published
Abstract [en]

Background:

Severe acute child malnutrition (SAM) is associated with high risk of mortality. To increase programme effectiveness in management of SAM, community-based management of acute malnutrition (CMAM) programme that treats SAM using ready-to-use-therapeutic foods (RUTF) has been scaled-up and integrated into existing government health systems. The study aimed to examine caregivers’ and health workers perceptions of usages of RUTF in a chronically food insecure area in South Ethiopia.

Methods:

This qualitative study recorded, transcribed and translated focus group discussions and individual interviews with caregivers of SAM children and community health workers (CHWs). Data were complemented with field notes before qualitative content analysis was applied.

Results:

RUTF was perceived and used as an effective treatment of SAM; however, caregivers also see it as food to be shared and when necessary a commodity to be sold for collective benefits for the household. Caregivers expected prolonged provision of RUTF to contribute to household resources, while the programme guidelines prescribed RUTF as a short-term treatment to an acute condition in a child. To get prolonged access to RUTF caregivers altered the identities of SAM children and sought multiple admissions to CMAM programme at different health posts that lead to various control measures by the CHWs.

Conclusion:

Even though health workers provide RUTF as a treatment for SAM children, their caregivers use it also for meeting broader food and economic needs of the household endangering the effectiveness of CMAM programme. In chronically food insecure contexts, interventions that also address economic and food needs of entire household are essential to ensure successful treatment of SAM children. This may need a shift to view SAM as a symptom of broader problems affecting a family rather than a disease in an individual child.

Place, publisher, year, edition, pages
2015. Vol. 30, no 10, 1334-1341 p.
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:uu:diva-246617DOI: 10.1093/heapol/czv003ISI: 000366493200010OAI: oai:DiVA.org:uu-246617DiVA: diva2:793898
Available from: 2015-03-09 Created: 2015-03-09 Last updated: 2017-05-11Bibliographically approved
In thesis
1. Integrated community-based management of severe acute child malnutrition: Studies from rural Southern Ethiopia
Open this publication in new window or tab >>Integrated community-based management of severe acute child malnutrition: Studies from rural Southern Ethiopia
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The World Health Organization (WHO) recommends the community-based Outpatient Therapeutic Program (OTP) as a standard treatment protocol for the management of uncomplicated Severe Acute Malnutrition (SAM) at the community level. OTP has been scaled up and integrated into the existing grassroots level government health systems in several developing countries. The aim of this thesis was to assess the implementation and outcome of a scaled-up and integrated OTP service provided at community level.

Methods: One qualitative study and three quantitative studies were conducted in southern Ethiopia. Children admitted to 94 integrated OTPs, their caregivers and health extension workers providing primary health care services in the nearby health posts were included in this study. The quantitative studies were based on data generated from observation of a cohort of 1,048 children admitted to the integrated OTPs.

Result: On admission 78.8% of the children had SAM. The majority of these children 60.2% exited the program neither achieving program recovery criteria nor being transferred to inpatient care. Fourteen weeks after admission to OTP, 34.6% were severely malnourished and 34.4% were moderately malnourished, thus 69.0% were still acutely malnourished. Ready-to-use Therapeutic Foods (RUTFs) provided for SAM children were commonly shared with other children in the household and sold as a commodity for the collective benefit of the family thus admitted children received only a portion of the provided amount. Further, the program suffered a severe shortage of RUTFs, where only  46.6% of admitted children were given the recommended amount of RUTFs by providers on admission and only 34.9% of these had uninterrupted provision during the follow-up.

Conclusion: The integrated OTPs we studied provide a constrained service and the use of RUTFs by families is not as intended by the program. The majority of admitted children remained acutely malnourished after participating in the program for the recommended duration. For integrated OTPs to be effective in chronically food-insecure contexts, interventions that also address the economic and food needs of the entire household are essential. This may require a shift to view SAM as a symptom of broader problems affecting a family rather than as a disease of an individual child. In addition, further research is needed to understand the health system context regarding RUTFs and medication supply and service utilization of integrated OTPs.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 62 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1232
Keyword
Severe acute malnutrition, integrated outpatient therapeutic programme, programme outcome, recovery, Ethiopia
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-292781 (URN)978-91-554-9601-2 (ISBN)
Public defence
2016-08-26, Betty Petterssonsalen, Blåsenhus, von Kraemers allé 1, Uppsala, 09:15 (English)
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Available from: 2016-06-02 Created: 2016-05-09 Last updated: 2016-06-22

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