Carers’ knowledge of treatment of severe acute malnutrition at Dadaab refugee complex, Kenya: A prospective cohort study

Abstract

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Globally, about 55 million children under the age of 5 years (10%) are undernourished. Of these, 19 million suffer from severe acute malnutrition (SAM). [1] SAM contributes to about one million deaths every year in children under the age of 5 years. [1,2] Most SAM cases are from sub-Saharan Africa and South Asia. [3] The prevalence of SAM is generally higher in emergency contexts and contributes to about half of the deaths in children under the age of 5 years in refugee camps. [4] Initially, therapeutic feeding centres treated SAM cases through inpatient care. They admitted all children with SAM, with or without medical complications. This approach was associated with high mortality and default rates. [4] To address setbacks associated with this approach, the community-based management of acute malnutrition (CMAM) model was globally adopted in 2007 and implemented the same year in Kenya. [5,6] CMAM entails treatment of SAM cases at community level using ready-to-use therapeutic foods. In this model, SAM cases without medical complications are treated as outpatients in an outpatient therapeutic feeding programme (OTFP) and those with medical complications are treated as inpatients at stabilisation centres (SCs). [7] Programmes that integrate the CMAM model in an existing health system are referred to as integrated management of acute malnutrition. [5] In Kenya, such integrated programmes are implemented in both rural areas and refugee camp settings using the same national treatment guidelines. However, despite successes being reported through the implementation of the CMAM model, poor treatment outcomes, such as high default rates and long recovery periods, are still being reported. [2,4,8] Studies from paediatric clinical settings suggest that carers' lack of understanding on the nature of treatment may contribute to poor adherence to treatment modalities. [9,10] No studies have assessed carers' understanding of the nature of treating acute malnutrition in a refugee population. The aim of this study was therefore to describe carers' knowledge of treating SAM at the Dadaab refugee complex. Methods Study setting The study was conducted between 21 May and 31 July 2015 at the Dadaab refugee complex in Garissa County, Kenya. The complex consists of four refugee camps, namely Hagadera, Dagahaley, Ifo I and Ifo II. The majority (97.5%) of the refugees are of Somalian nationality. [11] Two camps (Ifo I and Hagadera) were randomly selected from the four sites. At the time of the study, Hagadera had a population of ~106 751 adults and 21 351 children under the age of 5 years, while the Ifo camp had a population of 84 269 adults and 16 854 children under the age of 5 years. [12,13] CMAM services were provided by the International Rescue Committee and Islamic Relief Kenya. Each camp had a CMAM Background. Severe acute malnutrition causes half of the deaths in children under the age of 5 years in refugee camps. Objective. To describe carers' ...

Achievement of adequate weight gain among infants and children with complicated severe acute malnutrition receiving treatment in therapeutic feeding centers of South Sudanese refugee camps in Ethiopia

“… 21 Studies in India, 22 Bangladesh 15 , and Democratic Republic of Congo 14 also reported comparable levels of achievement of weight gain among children with complicated SAM. In contrast, higher proportion of treated patients achieved adequate weight gain in this study when compared with other studies conducted in the Dadaab refugee camp of Kenya 23 and Jimma university referral hospital of Ethiopia. 24 The proportion of treated children who achieved adequate weight gain was also higher than the level reported from India.…”

“…This was consistent with other findings where weight gain varied between TFUs, as explained by a study conducted in Dadaab refugee camp in Kenya. 23 In addition, other studies conducted on non-refugee populations in Ethiopia also reported existence of differences between compared TFUs in Debre Birhan, 36 East Amhara, 17 and Mekele. 19 This could be due to differences in the level of care provided in the facilities, staffing, and the condition of patients admitted to the centers.…”

Understanding malnutrition management through a socioecological lens: Evaluation of a community‐based child malnutrition program in rural Uganda

“…The first theme demonstrated that caregivers' characteristics could influence outpatient malnutrition management. Our results are consistent with other CMAM program evaluations showing that caregivers in low‐resource settings may have a limited understanding of malnutrition (Isanaka et al, 2020; Mbogo et al, 2020; Peter et al, 2019; Ware, 2018). Our findings showed that most caregivers associated malnutrition with weight loss, having difficulty identifying other signs.…”

Understanding malnutrition management through a socioecological lens: Evaluation of a community-based child malnutrition program in rural Uganda

“…The first theme demonstrated that caregivers’ characteristics and practices could influence malnutrition management. Our results are consistent with evaluations of other CMAM programs showing that caregivers in low-resource settings may have limited understandings of malnutrition (Isanaka et al, 2020; Mbogo et al, 2020; Peter et al, 2019; Ware, 2018). Our findings showed that most caregivers associated nutrition with weight loss, having more difficulty identifying other signs of malnutrition.…”

“…Our results are consistent with other evaluations of CMAM programs in LMICs showing that caregivers in low-resource settings may have limited understanding of malnutrition and its complex mechanisms. [51][52][53][54] Our findings showed that most caregivers perceived undernutrition as being associated with weight loss and caused by poor feeding habits. Interestingly, a study conducted in India concluded that caregivers did not perceive malnutrition as a disease and were less likely to consult health professionals if their children were 'only skinny'.…”