Community-Based Management of Child Malnutrition in Zambia: HIV/AIDS Infection and Other Risk Factors on Child Survival

Moramarco, Stefania; Ciarlantini, Clarice; Chipoma, Jean Kasengele; Simpungwe, Matilda Kakungu; Nielsen‐Saines, Karin; Palombi, Leonardo; Buonomo, E

doi:10.3390/ijerph13070666

Cited by 14 publications

(20 citation statements)

References 15 publications

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“…Even though the average length of stay in therapeutic centres is longer than a couple of studies conducted in Ethiopia in Wolisso (14 days), and Debre Markos and Finote Selam (11 days),16 17 it was still acceptable according to the WHO recommendation, which is an average of 30 days 11. The recovery time was also faster when compared with several studies conducted in southern Ethiopia, (22 days (oedematous) and 29 days (non-oedematous)), Shebedibo woreda (35 days),18 19 Mekelle (17 days)20 and Zambia (24 weeks) 21. The possible reason for this discrepancy could be related to the difference in sociodemographic characteristics among the participants and/or the difference in the magnitude of comorbidities and adherence to the standard treatment protocol.…”

Section: Discussionmentioning

confidence: 60%

Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia

et al. 2020

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ObjectivesThis study aimed to determine the time to recovery from severe acute malnutrition (SAM) and its predictors in selected public health institutions in Amhara Regional State, Ethiopia.DesignAn institution-based retrospective follow-up study was conducted using data extracted from 1690 patient cards from September 2012 to November 2016.SettingSelected government health institutions in the Amhara region, Ethiopia.ParticipantsChildren treated in therapeutic feeding units for SAM were included.Outcome measuresTime to recovery from SAM.ResultsOne thousand and fifty children have recovered from SAM, 62.13% (95% CI 59.8% to 64.5%). The median time to recovery was 16 days (IQR=11–28). Female gender (adjusted HR (AHR)=0.81, 95% CI 0.67 to 0.98), oedematous malnutrition (AHR=0.74 95% CI 0.59 to 0.93), pneumonia (AHR=0.66, 95% CI 0.53 to 0.83), tuberculosis (AHR=0.53, 95% CI 0.36 to 0.77), HIV/AIDS (AHR=0.47, 95% CI 0.28 to 0.79), anaemia (AHR=0.73, 95% CI 0.60 to 0.89) and receiving vitamin A (AHR=1.43, 95% CI 1.12 to 1.82) were notably associated with time to recovery.ConclusionsThe time to recovery in this study was acceptable but the proportion of recovery was far below the minimum standard. Special emphasis should be given to the prevention and treatment of comorbidities besides the therapeutic feeding. Supplementing vitamin A would also help to improve the recovery rate.

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Section: Discussionmentioning

confidence: 60%

Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia

et al. 2020

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“…The main socio-demographic characteristics of the enrolled children in 2015–17, comorbidity and nutritional status at baseline, are reported in Table 1 , and compared with data for 2012–14 previously published [ 20 ]. All children came from low socio-economic households.…”

Section: Resultsmentioning

confidence: 99%

“…Revision of the food schedule (doubling HEPS quantity and improving quality) and staff training support in HIV counseling and testing were the two main activities implemented during the last two years, after critical areas for improvement were identified during the previous program evaluation in 2012–14 [ 20 ]. Nutritional counseling, emphasizing the use of locally available food, was also integrated as a routine activity of the SFPs, with pilot study results discussed elsewhere [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…The aim of the current study was primarily to demonstrate the Rainbow SFPs’ effectiveness in the community-based management of child malnutrition in Zambia, by presenting an innovative approach run by well-trained community volunteers, integrating treatment and prevention of MAM, SAM, and being underweight. Therefore, program outcomes between the years of 2015–17 were evaluated and compared with International Standards and previous study results (Rainbow 2012–14), after filling the gaps in prior activities [ 20 ]. Secondly, the current study aimed to demonstrate that Rainbow SFPs can act as an integrated program for nutrition and child health promotion, coupling growth surveillance with HIV counseling and diagnosis, facilitating access to HIV/TB treatment and overall care for Zambian children.…”

Section: Introductionmentioning

confidence: 99%

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Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

Moramarco

Chipoma²,

Nielsen‐Saines

et al. 2018

IJERPH

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Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.

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“…Thus, RUSF are often recommended in chronic malnutrition to add essential nutrients to the standard diet during food insecurity. Supplemental feeding projects like the completed Rainbow Project in Zambia further provide evidence for the value of RUTF use [43]. Overall, in the present study the participants displayed a general knowledge of the types of food that are recommended for consumption during pregnancy to provide adequate nutrient intake for mothers and infants.…”

Section: Discussionmentioning

confidence: 55%

Healthy pregnancies and essential fats: focus group discussions with Zambian women on dietary need and acceptability of a novel RUSF containing fish oil DHA

Chunda‐Liyoka

Lubeya

Imakando

et al. 2020

BMC Pregnancy Childbirth

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Background: Nut butter-based Ready to Use Supplemental Foods (RUSF) are an effective way to add nutrients and calories to diets of malnourished and food insecure populations. The RUSF formulations have been further modified to add micronutrients including iron and folic acid needed during pregnancy and lactation. Because docosahexaenoic acid (DHA, C22:6 n-3) enhances fetal development and birth outcomes, it has been suggested that perhaps RUSF formulations for pregnancy should also include this Omega 3 fatty acid. The goal of the present study was to gain an understanding of Zambian women's knowledge of nutritional needs in pregnancy through structured focus group discussions, and to formulate and determine the acceptability of a RUSF with DHA. Methods: Structured focus group sessions were conducted among women attending an antenatal clinic at the University Teaching Hospitals in Lusaka, Zambia. Dietary and nutrition knowledge was surveyed through structured dialogue that was recorded by audio and transcribed verbatim. An RUSF containing 400 mg DHA from fish oil in 50 g RUSF was designed and assessed for fatty acid content and product stability. Participants then sampled the RUSF-DHA, provided feedback on taste, and were surveyed about willingness to consume the novel formula using a standardized hedonic instrument. Results: The participants' knowledge of foods recommended for use in pregnancy included fruits, vegetables, meat, and fish. Most women reported eating fish at least once per week, although the specific type of fish varied. Most did not have prior knowledge of the importance of consuming fish during pregnancy or that some fish types were more nutritional than others as they included omega 3 fatty acids. The participants were uniformly accepting of the RUSF-DHA for the purpose of enhancing birth and developmental outcomes, but were critical of the aroma in hedonic testing. Conclusions: Women were committed to consuming a healthy diet that would impact the outcome of pregnancy, and were receptive to advice on the importance of consuming foods such as fish as a source of DHA. The RUSF-DHA formulation was acceptable due to the potential benefits for the developing infant, however, the fishy odor may be limiting for long-term daily use.

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Community-Based Management of Child Malnutrition in Zambia: HIV/AIDS Infection and Other Risk Factors on Child Survival

Cited by 14 publications

References 15 publications

Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia

Time to recovery from severe acute malnutrition and its predictors: a multicentre retrospective follow-up study in Amhara region, north-west Ethiopia

Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

Healthy pregnancies and essential fats: focus group discussions with Zambian women on dietary need and acceptability of a novel RUSF containing fish oil DHA

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