Challenges in Implementing the Integrated Community-Based Outpatient Therapeutic Program for Severely Malnourished Children in Rural Southern Ethiopia.

Elazar Tadesse,Yemane Berhane,Eva-Charlotte Ekström

doi:10.3390/nu8050251

Elazar Tadesse, Yemane Berhane + Show 1 more

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https://doi.org/10.3390/nu8050251

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Abstract

Currently, treatment of uncomplicated severe acute malnutrition is managed in the integrated Community based Outpatient Therapeutic Program (C-OTP) using ready-to-use therapeutic foods (RUTFs). The aim of this study was to determine challenges in implementing the critical steps in C-OTP and caregivers’ perceptions of service provision in southern Ethiopia. A total of 1048 caregivers of children admitted to the OTP and 175 Health Extension Workers (HEWs) from 94 selected health posts were included in the study. Program admission, follow-up and exit information was collected from caregivers during home visits. HEWs were interviewed at their respective health posts. Only 46.6% (481/1032) were given the recommended amount of RUTF and 19.3% (196/1015) were given antibiotics on admission. During C-OTP participation 34.9% (316/905) had uninterrupted provision of the recommended amount of RUTF. Of the children who left the program, 220/554 (39.7%) exited the program in line with the national recommendation. Caregivers (42.9% (394/918) and HEWs (37.1%, 62/167) perceive that RUTFs were being sold as a commodity. Inadequate provision and unintended usage of RUTFs, lack of antibiotics and inappropriate exit from the program were major constraints. For successful saving of lives, adequate resources must be allocated, and providers must be trained regularly, and supervised properly.

Highlights

19 million children under five are suffering from Severe Acute Malnutrition (SAM) [1].Three out of four children diagnosed with SAM are uncomplicated, and the majority have a good appetite for ready-to-use therapeutic foods (RUTF) and do not have co-morbidities [2,3,4]
Efficient provision and proper use of RUTFs is critical for reducing childhood severe acute malnutrition
Availability of RUTFs should be ensured through application of appropriate supply chain and monitoring policy

Summary

Introduction

Three out of four children diagnosed with SAM are uncomplicated, and the majority have a good appetite for ready-to-use therapeutic foods (RUTF) and do not have co-morbidities [2,3,4]. Health Organization (WHO) recommends the Community-based Outpatient Therapeutic Program (C-OTP) as a standard treatment protocol for the management of uncomplicated SAM at the community level [4,5]. Where children are diagnosed, classified and treated for SAM by Community Health Workers (CHWs). CHWs have limited training and have many other responsibilities; one would expect SAM management is likely to differ from small-scale programs which are implemented by non-governmental organizations [3,5]. Based on achievements from small-scale programs, C-OTP has been scaled up and integrated into the lowest level government health systems in several developing countries [6,7,8,9]

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