Acute malnutrition recovery rates improve with COVID-19 adapted nutrition treatment protocols in South Sudan: a mixed methods study

Abstract

Background Globally, emergency nutrition program adaptations were implemented as part of COVID-19 mitigation strategies, but the implications of the adoption of all protocol changes at scale in the context of deteriorating food security are not yet well characterized. With ongoing conflict, widespread floods, and declining food security, the secondary impacts of COVID-19 on child survival in South Sudan is of great concern. In light of this, the present study aimed to characterize the impact of COVID-19 on nutrition programming in South Sudan. Methods A mixed methods approach including a desk review and secondary analysis of facility-level program data was used to analyze trends in program indicators over time and compare two 15-month periods prior to the onset of COVID-19 (January 2019 – March 2020; “pre-COVID period”) and after the start of the pandemic (April 2020 – June 2021; “COVID” period) in South Sudan. Results The median number of reporting Community Management of Acute Malnutrition sites increased from 1167 pre-COVID to 1189 during COVID. Admission trends followed historic seasonal patterns in South Sudan; however, compared to pre-COVID, declines were seen during COVID in total admissions (− 8.2%) and median monthly admissions (− 21.8%) for severe acute malnutrition. For moderate acute malnutrition, total admissions increased slightly during COVID (1.1%) while median monthly admissions declined (− 6.7%). Median monthly recovery rates improved for severe (92.0% pre-COVID to 95.7% during COVID) and moderate acute malnutrition (91.5 to 94.3%) with improvements also seen in all states. At the national level, rates also decreased for default (− 2.4% for severe, − 1.7% for moderate acute malnutrition) and non-recovery (− 0.9% for severe, − 1.1% for moderate acute malnutrition), with mortality rates remaining constant at 0.05–0.15%. Conclusions Within the context of the ongoing COVID-19 pandemic in South Sudan, improved recovery, default, and non-responder rates were observed following adoption of changes to nutrition protocols. Policymakers in South Sudan and other resource-constrained settings should consider if simplified nutrition treatment protocols adopted during COVID-19 improved performance and should be maintained in lieu of reverting to standard treatment protocols.

Trends and Determinants of Children’s Wasting and Women’s Thinness in Chad, 2015 to 2021

“…For example, in South Sudan during COVID-19, there was a shift away from facility-based nutrition services to stand alone community-based acute malnutrition sites and community care, and these changes were associated with increases in enrollment, reductions in treatment costs, and no negative change in recovery rates. 27 Combining geospatial analysis techniques with prevalence data from the analyzed SMART surveys would provide a powerful tool for a targeted scale-up of such interventions to address malnutrition in less accessible areas. Innovative approaches to reach excluded or marginalized populations . Our analysis suggests that women and children in predominantly pastoral households are more likely to suffer malnutrition, consistent with other studies on nomadic populations in Chad.…”

Impact of COVID-19 program adaptations on costs and cost-effectiveness of community management of acute malnutrition program in South Sudan

“…Additionally, the reduction in visit frequency from weekly to biweekly for SAM children and biweekly to monthly for MAM children likely resulted in reduction in non-RUF consumable supplies and programme operation costs including running generator, transportation of staff to and from nutrition sites. The number of CMAM treatment sites nationally increased during COVID-19, however, compared with before COVID, total CMAM admissions declined at a national level, and those states with the largest declines in admissions also saw reductions in the number of treatment facilities ( 15 ) . From this analysis, we cannot conclusively deduce that the reduction in unit cost is entirely related to the protocol modification.…”

“…This cost-effectiveness study was nested within a broader evaluation of COVID--19 nutrition program adaptations that explored the impact of the COVID-19 pandemic on CMAM programming ( 15 ) . We only considered NGO-associated cost for running CMAM programs based on original CMAM guidelines before COVID-19 and modified guidelines during COVID-19.…”

A Prospective Comparison of Standard and Modified Acute Malnutrition Treatment Protocols during COVID-19 in South Sudan

“…Findings from this study align with other recent evidence indicating that modified protocols were associated with improved CMAM outcomes during COVID-19 in South Sudan. A national analysis of CMAM program trends from 2019 to 2021 observed that OTP and TSFP recovery rates increased by 3.7% and 2.8%, respectively, during COVID-19 [18]. Another recent analysis of children treated for OTP in five states of South Sudan observed significantly higher recovery rates and odds of recovery under modified protocols compared to the standard protocol (AORs: 1.8-2.4, depending on the protocol) and significantly shorter LoS among all modified protocols [19].…”