Outpatient Therapeutic Program Research Articles

Outcomes of Severely Malnourished Children Aged 6 - 59 Months on Outpatient Management Program in Kitui County Hospital, Kenya

Severe acute malnutrition is a widely prevalent problem in developing countries and a major cause of morbidity and mortality. Traditionally, children with severe acute malnutrition were rehabilitated within inpatient services. Advent of ready to use therapeutic food made it possible to treat majority of these children in their homes. However, there is limited data about the outcomes of the program. Objectives: To determine the outcomes (recovery, default, mean weight gain and non-response rates) of severely malnourished children aged 6 - 59 months enrolled in outpatient therapeutic program at Kitui County Hospital. Methodology: A prospective longitudinal study design was carried out for one month. Hundred and four (104) children with SAM were recruited in the study. Anthropometric measurements, physical examination and appetite test of the children were conducted on a weekly basis for 28 days. Descriptive analysis was conducted using means, frequency and proportions. Paired t test was computed for mean weight gain and mid-upper arm circumference between admission and subsequent visits. Results: The findings of the study revealed that the recovery rate was 73.3%, weight gain rate of 5.1 g/kg/day, defaulter rate was 2.9% and non-response rate was 13.9% (WHZ = -3SD). Mean weight increased from 6.8 kg on the 1st visit to 7.5 kg in the 4th visit (P = 0.000) and the meanmid-upper arm circumferenceincreased from 11.1 cm at admission to 11.9 cm at 4th visit (P = 0.000). Conclusion: The recovery and weight gain rates were below the global acceptable SPHERE of minimum standards (recovery rate > 75% and weight gain rate > 8 g/kg/day). The defaulter rate was within the acceptable international standards (

Recovery Rate and Determinants in Treatment of Children with Severe Acute Malnutrition using Outpatient Therapeutic Feeding Program in Kamba District, South West Ethiopia

Introduction: Globally approximately one million children die every year from severe acute malnutrition. It is reported that severe acute malnutrition(SAM) is the commonest reason for paediatric hospital admission in many poor countries; 25 to 30% of children with severe malnutrition die during hospital admissions. Objective: To assess the success rate of OTP in treatment of children with SAM and identify its determinants at Kamba district, South West Ethiopia. Method: Institution based retrospective longitudinal study was carried out on children who were treated on the OTP. A total sample of 711 was selected from 4 health centers and 12 satellite health posts. A structured and pretested data abstraction form were prepared and used for data collection. The data were cleaned, coded and entered into Epi-INFO, analyzed by SPSS. The results were estimated using Kaplan-Meier survival curves, log-rank test and Cox-regression. Result: The recovery rate was 67.7% and the median recovery time was 7.14 weeks (IQR 5.28-8.14). Children treated at a health centers have 1.36 times higher recovery rate than children treated at health post (AHR = 1.495, 95% CI = 1.188, 1.881). Controlling for other factors; the probability of a child to recover from SAM under OTP is 1.25 times higher among children aged greater than two years old than those children aged less than or equal to two years old (AHR = 1.255, 95% CI = 1.012, 1.556). Conclusion and Recommendation: The recovery rate was lower than the international standard. Type of health facility providing the OTP services and age of the child had significant association (at 0.05 P-value) with survival time among children who recovered from SAM under OTP. Special focus should be given to young children and decentralization of OTP service from health centers to health posts should be carried out with great caution.

Outpatient Treatment of Severe Acute Malnutrition

A study of an outpatient therapeutic feeding program explores patient outcomes and factors contributing to recovery from severe acute malnutrition (SAM).

Effectiveness of Indigenous Ready-to-Use Therapeutic Food in Community-based Management of Uncomplicated Severe Acute Malnutrition: a Randomized Controlled Trial from India

A randomized controlled trial was conducted in Chandigarh, India (2011), to determine the effectiveness of indigenous ready-to-use therapeutic food (RUTF) in community-based management of uncomplicated severe acute malnutrition (SAM). Intervention was through outpatient therapeutic program site (OTP). Study and control group children (6 months-5 years) were followed up weekly for 12 weeks, in OTP and at home. All children received supplementary nutrition through anganwadis under integrated child development scheme. Study children, in addition, received therapeutic dose of RUTF in OTP. Primary outcome, 115% of baseline weight, was attained in 6 of 13 (46.2%) and 1 of 13 (7.7%) children among study and control group, respectively [odds ratio: 10.28, 95% confidence interval (CI): 1.02-103.95]. Compared with control group, addition of RUTF in study group resulted in average additional increase in weight by 13 g/kg of baseline weight/week/child (95% CI: 2-23). Indigenous RUTF was effective in community-based management of uncomplicated SAM.

Outpatient Therapeutic Feeding Program Outcomes and Determinants in Treatment of Severe Acute Malnutrition in Tigray, Northern Ethiopia: A Retrospective Cohort Study

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.

The Effect of Task-Specific Self-Efficacy on Stages of Change of People With Substance Abuse Problems

AbstractThe objective of the study was to determine the effect of task-specific self-efficacy on stages of readiness for change among people with substance abuse problems. Participants were 140 men and 33 women with substance abuse problems receiving services in outpatient therapeutic community service programs. The Stages of Change Scale-Substance Abuse (SCS-SA) was the outcome measure. People with substance abuse problems receiving outpatient treatment services can be meaningfully classified into four stages of change groups: (1) Precontemplation, (2) Inactive, (3) Ambivalent-Conforming, and (4) Participation. Readiness for change is related to self-efficacy in work-related skills and risk-avoidance skills. Task-specific self-efficacy is related to stages of change. The findings of this study suggested that providing skill training to enhance task specific self-efficacy can help people with substance abuse problems progress from lower level to higher level of stages of change.

The Use of Home-Based Therapy with Ready-to-Use Therapeutic Food to Treat Malnutrition in a Rural Area during a Food Crisis

When the international community declared a famine in Malawi in January of 2006, emergency food aid reached only populations with pre-existing health care services. To treat the widespread childhood malnutrition in Machinga district, a rural area lacking health care facilities, in February 2006 five outpatient therapeutic programs were implemented that utilized home-based therapy and ready-to-use therapeutic food. Children with severe malnutrition, defined as the presence of edema and/or a weight-for-height less than 70% of the reference standard, were enrolled in the program. Two senior clinical nurses trained village health aides in each of the five communities. Children visited the health aides biweekly. During the visits, health aides collected demographic and anthropometric information and distributed a 2-week supply of ready-to-use therapeutic food, providing 175 kcal/kg/d. Treatment continued for 8 weeks; children were discharged before 8 weeks if they reached a weight-for-height more than 100% of the reference standard, or required admission to the hospital due to systemic infection or recurrence of edema. Of the 826 children enrolled, 775 (93.7%) recovered, 13 (1.8%) remained malnourished, 30 (3.6%) defaulted, and 8 (0.9%) died. Mean weight gained was 2.7±3.7 g/kg/d, height gained 0.3±0.9 mm/d, and mid-upper arm circumference gained 0.2±0.3 mm/d. Home-based therapy with ready-to-use therapeutic food administered by village health aides is an effective approach to treating malnutrition during food crises in areas lacking health services.

Assessment of outpatient therapeutic programme for severe acture malnutrition in three regions of Ethiopia

To document the experiences and lessons for rolling out of the OTP service at the wider scale with the aim of assessing the strengths and weaknesses of the project and suggest recommendations for future programming. Qualitative methods of data collection including focus group discussion, observation and in-depth interview of key informants were employed to get relevant data. Review of health facility, reports and programme documents were done to capture further- information. Out Patient Programme (OTP) pilot programme implemented by CONCERN/ VALID in three administrative regions of Ethiopia namely: South Nations and Nationalities Peoples Regions (SPNNR), Addis Ababa and Oromia regions. A total of thirteen health centres which had started OTP service from the three regions were included in the study. Thirty six key informants and 30 focus group discussants were involved in the study conducted from 16th to 25th November 2006. Out Patient Programme (OTP) has enhanced community's understanding of malnutrition as a health problem through an excellent entry point it created for behaviour change communication (BCC) on optimal infant and young child feeding (IYCF). It has also enhanced utilisation of the existing equipments of the respective health services to promote nutrition and increased mental satisfaction of the providers who observed rapid recovery of malnourished children taking the plumpy nut. It also resulted in increased awareness of the community about malnutrition and its treatment, which resulted in increased need-based demand for the OTP and self-referral of children to health facilities. Shift in the thinking of the providers on the fact that malnutrition can be treated without admitting the child and reduction in the burden of malnutrition and associated mortality are other positive findings of the study. While it was observed that the programme was very effective in treating case of severe acute malnutrition and is highly acceptable by planners, health care providers and beneficiaries, there were different operational issues that needed to be strengthened. The irregularity and incompleteness of supply availability, high attrition of trained human power, inadequate supportive supervision especially from local ministry of health, inadequate community mobilisations are some of the shortcomings identified. Based of these findings recommendations were forwarded.

The management of psychiatric comorbidity in an outpatient individual therapeutic program of addiction

During last years there is an increasing tendency to develop treatments specifically tailored for addicted patients with psychiatric comorbidity. The Counseling Center offers an outpatient, drug counseling individual psychotherapeutic program. No medical treatment is administered except naltrexone which is prescribed to some selected heroin addicted users.As substance use disorders and psychiatric disorders (psychotic, affective and anxiety disorders) commonly co-occur it is of great importance to facilitate early diagnosis so the therapist will be able to design the optimal management of users with a comorbid psychiatric disorder. If there is an evidence of comorbidity the user is also referred to a psychiatrist other than the drug counseling therapist who diagnoses and has the responsibility for the medical and psychotherapeutic treatment of this disorder.The therapists' collaboration has two main intents: the abstinence from drug use and the recovery from the psychiatry disorder. In case abstinence is not succeeded or the comorbid disorder is not optimally treated the outcome of the treatment effort will not be successful.Furthermore it is also important to give detailed information to the user about the therapeutic process and the way in which drug use contributes to the development and the maintenance of the psychiatric disorder. As for heroin users with psychiatric comorbidity the prescription of naltrexone will also be very helpful.

Key Issues in the Success of Community-Based Management of Severe Malnutrition

Acute malnutrition is an underlying factor in almost 50% of the 10 to 11 million children under 5 years of age who die each year of preventable causes. Inpatient treatment for severe acute malnutrition is associated with high opportunity and economic costs for affected families and health service providers. Community-based therapeutic care attempts to address these problems and to maximize population-level impact through improving coverage, access, and cost-effectiveness of treatment. THE COMMUNITY-BASED THERAPEUTIC CARE MODEL: Community-based therapeutic care programs provide effective care to the majority of acutely malnourished people as outpatients, using techniques of community mobilization to engage the affected population and maximize coverage and compliance. People with severe acute malnutrition without medical complications are treated in an outpatient therapeutic program with ready-to-use therapeutic food and routine medication. Those suffering from severe acute malnutrition with medical complications are treated in an inpatient stabilization center according to standard World Health Organization protocols until they are well enough to be transferred to the outpatient therapeutic program. IMPACT OF COMMUNITY-BASED THERAPEUTIC CARE PROGRAMS: Twenty-one (21) community-based therapeutic care programs were implemented in Malawi, Ethiopia, and North and South Sudan between 2000 and 2005. These programs, which treated 23,511 cases of severe acute malnutrition, achieved recovery rates of 79.4% and mortality rates of 4.1%. Coverage rates were approximately 73%. Of the severely malnourished children who presented, 76% were treated solely as outpatients. Initial data indicate that these programs are affordable, with the cost-effectiveness of emergency community-based therapeutic programs varying from US$12 to US$132 per year of life gained.

1165-106 Outpatient clinic base therapeutic program of exercise after heparin administration for patients with arteriosclerosis obliterans

1165-106 Outpatient clinic base therapeutic program of exercise after heparin administration for patients with arteriosclerosis obliterans

Outpatient care for severely malnourished children in emergency relief programmes: a retrospective cohort study

In emergency nutritional relief programmes, therapeutic feeding centres are the accepted intervention for the treatment of severely malnourished people. These centres often cannot treat all the people requiring care. Consequently, coverage of therapeutic feeding centre programmes can be low, reducing their effectiveness. We aimed to assess the effectiveness of outpatient treatment for severe malnutrition in an emergency relief programme. We did a retrospective cohort study in an outpatient therapeutic feeding programme in Ethiopia from September, 2000, to January, 2001. We assessed clinical records for 170 children aged 6-120 months. The children had either marasmus, kwashiorkor, or marasmic kwashiorkor. Outcomes were mortality, default from programme, discharge from programme, rate of weight gain, and length of stay in programme. 144 (85%) patients recovered, seven (4%) died, 11 (6%) were transferred, and eight (5%) defaulted. Median time to discharge was 42 days (IQR 28-56), days to death 14 (7-26), and days to default 14 (7-28). Median rate of weight gain was 3.16 g kg(-1) x day(-1) (1.86-5.60). In patients who recovered, median rates of weight gain were 4.80 g kg(-1) day(-1) (2.95-8.07) for marasmic patients, 4.03 g x kg(-1) x day(-1) (2.68-4.29) for marasmic kwashiorkor patients, and 2.70 g x kg(-1) x day(-1) (0.00-4.76) for kwashiorkor patients. Outpatient treatment exceeded internationally accepted minimum standards for recovery, default, and mortality rates. Time spent in the programme and rates of weight gain did not meet these standards. Outpatient care could provide a complementary treatment strategy to therapeutic feeding centres. Further research should compare the effectiveness of outpatient and centre-based treatment of severe malnutrition in emergency nutritional interventions.