Nutritional and morbidity outcomes of children managed for severe acute malnutrition in Jigawa State, Nigeria

Abstract

Introduction: The community-based approach to the management of severe acute malnutrition (SAM) is a cost effective and scientifically sound method of mitigating the soaring burden of under-five malnutrition in resource constrained countries. However, since the adoption of this novel intervention in Nigeria, local studies that have evaluated its overall effectiveness are sparse. Methodology: This longitudinal observational study was designed to assess at discharge, the nutritional status, as well as the nutritional related co-morbidities of 494 children enrolled into the Community Management of Acute Malnutrition (CMAM) programme. It is part of an impact evaluation study. The parameters evaluated at enrolment and at discharge included the anthropometry, presence of common morbidities and immunization status. Data were captured electronically with the aid of CSPro software. The study was carried out across 10 randomly selected CMAM clinics in Jigawa state, North West Nigeria. Result: Out of the 494 malnourished children recruited, 410 were discharged, the remaining were reported as absconded or died, with an average duration of stay of 7.3±1.6 weeks in the clinics, and a discharge cure rate of 63.4%. There was improvement in the mean weight (6.0kg at enrolment vs 7.3kg at discharge, p=0.000), mean occipito-frontal circumference (44.1cm at enrolment vs 45.3cm at discharge, p=0.000) and Weight-for-Height z score (-2.65 at enrolment vs 0.75 at discharge, p=0.000 ). A significant discordance in the nutritional outcome at discharge, as assessed independently by Mid Upper Arm Circumference (MUAC) and Weight-for-Height z score (WHZ), was documented; 9% and 28% still had SAM at discharge based on MUAC and WHZ respectively (p=0.000). The burden of nutritional related morbidities (diarrhoea dysentery, refusal to eat) reduced significantly at discharge (p=0.000) while immunization coverage increased by 7%. Conclusion: The CMAM programme in Jigawa, Nigeria has undoubtedly yielded positive outcomes. However, proactive measures should be taken to achieve the Sphere standards recommended minimum discharge cure rate. This may be achieved by ensuring that health care workers continually adhere to the guiding principles of CMAM. There is also a need for introduction of HIV and tuberculosis screening as non-responders maybe infected by any of these diseases.