Abstract
BackgroundOutpatient Therapeutic feeding Program (OTP) brings the services for management of Severe Acute Malnutrition (SAM) closer to the community by making services available at decentralized treatment points within the primary health care settings, through the use of ready-to-use therapeutic foods, community outreach and mobilization. Little is known about the program outcomes. This study revealed the levels of program outcome indictors and determinant factors to recovery rate.MethodsA retrospective cohort study was conducted on 628 children who had been managed for SAM under OTP from April/2008 to January/2012. The children were selected using systematic random sampling from 12 health posts and 4 health centers. The study relied on information of demographic characteristics, anthropometries, Plumpy'Nut, medical problems and routine medications intakes. The results were estimated using Kaplan-Meier survival curves, log-rank test and Cox-regression.ResultsThe recovery, defaulter, mortality and weight gain rates were 61.78%, 13.85%, 3.02% and 5.23 gm/kg/day, respectively. Routine medications were administered partially and children with medical problems were managed inappropriately under the program. As a child consumed one more sachet of Plumpy'Nut, the recovery rate from SAM increased by 4% (HR = 1.04, 95%-CI = 1.03, 1.05, P<0.001). The adjusted hazard ratios to recovery of children with diarrhea, appetite loss with Plumpy'Nut and failure to gain weight were 2.20 (HR = 2.20, 95%-CI = 1.31, 3.41, P = 0.001), 4.49 (HR = 1.74, 95%-CI = 1.07, 2.83, P = 0.046) and 3.88 (HR = 1.95, 95%-CI = 1.17, 3.23, P<0.001), respectively. Children who took amoxicillin and de-worming had 95% (HR = 1.95, 95%-CI = 1.17, 3.23) and 74% (HR = 1.74, 95%-CI = 1.07, 2.83) more probability to recover from SAM as compared to those who didn't take them.ConclusionsThe OTP was partially successful. Management of children with comorbidities under the program and partial administration of routine drugs were major threats for the program effectiveness. The stakeholders should focus on creating the capacity of the OTP providers on proper management of SAM to achieve fully effective program.
Highlights
Severe Acute Malnutrition (SAM) is defined as weight-forheight ratio of less than 23 standard deviations below the median reference population or weight-for-height ratio of below 70% or presence of nutritional oedema [1].Directly or indirectly, malnutrition contributes to 53% of deaths of children under-five in developing countries
Ethiopia has taken the Outpatient Therapeutic feeding Program (OTP) as most important and accessible program to treat malnutrition. It is operational at health centers and health posts and offers the lifesaving treatments with ready-to-use therapeutic foods (RUTF), usually Plumpy’Nut
Study design and settings A retrospective cohort study was conducted among children aged 6–59 months who had been treated for SAM under the OTP from April 2008 to January 2012
Summary
Severe Acute Malnutrition (SAM) is defined as weight-forheight ratio of less than 23 standard deviations below the median reference population or weight-for-height ratio of below 70% or presence of nutritional oedema [1].Directly or indirectly, malnutrition contributes to 53% of deaths of children under-five in developing countries. Outpatient Therapeutic feeding Program (OTP) brings the service of management of SAM closer to the community by making services available at decentralized health facilities (primary health care units) in different resource limited countries such as Niger, North and South Sudan, Malawi, Chad and Ethiopia [6,7,8]. Ethiopia has taken the OTP as most important and accessible program to treat malnutrition It is operational at health centers and health posts and offers the lifesaving treatments with ready-to-use therapeutic foods (RUTF), usually Plumpy’Nut. Plumpy’Nut is energy, mineral and vitamin enriched paste-food designed to treat SAM (Table S1). Outpatient Therapeutic feeding Program (OTP) brings the services for management of Severe Acute Malnutrition (SAM) closer to the community by making services available at decentralized treatment points within the primary health care settings, through the use of ready-to-use therapeutic foods, community outreach and mobilization. This study revealed the levels of program outcome indictors and determinant factors to recovery rate
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