Abstract
To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community. Cross-sectional quality-of-care study. The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model. LHW implementing treatment for uncomplicated SAM in the community. Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %. This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.
Highlights
Severe acute malnutrition (SAM) is a major global public health challenge, with an estimated 16·5 million children under 5 years of age suffering from the condition[1]
This outpatient model has successfully reduced the burden on carers compared with inpatient care and limited the proportion of children defaulting from the programme while increasing treatment coverage[3]
The current paper presents the findings of a crosssectional study assessing the technical competence – quality of care – of lady health workers (LHW) managing cases of uncomplicated SAM in the community
Summary
Severe acute malnutrition (SAM) is a major global public health challenge, with an estimated 16·5 million children under 5 years of age suffering from the condition[1]. Nurses provide treatment during weekly visits to health centres which is continued in the home using ready-to-use therapeutic food (RUTF). This outpatient model has successfully reduced the burden on carers compared with inpatient care and limited the proportion of children defaulting from the programme while increasing treatment coverage[3]. Despite this success, treatment coverage of CMAM services remains low, often with less than 40 % of intended recipients receiving care[4]. The main barriers to access are a lack of knowledge about malnutrition and the availability of treatment among carers, and the high opportunity cost which continues to be associated with receiving treatment[4,5,6]
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