Treatment of severe acute malnutrition Experience from developmental context Jimma, Ethiopia

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Treatment of severe acute malnutrition
Experience from developmental context Jimma,
Ethiopia

• Tsinuel Girma
• Asst professor of Pediatrics and Child Health
• Jimma University
• Mar 2008 (2000)

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Child health indicators
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Current U5MR trend Vs MDG trend
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500,000 under-5 dying each yearRanking 6th in
the world 72 preventable
f
Other, 2
Measles, 4
AIDS, 1
Neonatal, 25
Malnutrition57
Diarrhea, 20
HIV/AIDS11
Malaria, 20
Pneumonia,
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Nutritional Status of Children Under Age Five
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Key interventions selected for targeted condition
NATIONAL STRATEGY FOR CHILD SURVIVAL IN
ETHIOPIA ,2005
Malnutrition Malnutrition
Prevention/promotion Clinical care
Breast feeding Complementary feeding Nutrition advice and supplementation Vitamin A supplementation PMTCT Measles vaccination Family Planning Management of severe acute malnutrition Vitamin A Zinc Nutrition advice
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In-patient treatment- hospital based

• Opened as part of pediatric in-patient service
  (Feb 2004)
• Maximum capacity of 30 patients
• Staff Feeders, nurses ,interns ,residents and
  consultants
• Implementation of national protocol
• Open 24 hrs

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Achievements
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Disciplined treatment, improved practicum
set-up, new outlook about treating SAM and
interest in nutrition related research
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• More than 1350 patients treated so far most with
  co-morbidities (TB/HIV)
• Death Rate lt 6
• ARWG 15g/kg/d
• ALOS 4 weeks

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Observed and expected deaths from Jimma TFUusing
Prudhon Index
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Out- Patient Treatment

• Context
• In 5 Health centers using RUTF (Dec 2005)
• Community mobilization and screening
• MOH is primarily responsible
• UNICEF provides RUTF and antibiotics
• Concern Ethiopia training
• Jimma University- Department of Pediatrics and
  Child Health

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Performance

• Post-training follow up, after 2 months in nine
  HCs showed
• Implementation within 34days (20-58)
• Enthusiastic health workers
• Good acceptance by mothers and caregivers (also
  demonstrated in another study)
• But
• Poor adherence to protocol ( one in five)
• Poor medical recording
• No proper evaluation of appetite (field tested
  )

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Types of malnutrition on admissionn324,four
health centers
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Treatment outcome
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Outcome

• RWG for recovered children was 6.0 g/ kg/d and
  no difference between types of malnutrition
• RWG for defaulters lt 5g/kg/d
• Length of stay for all recovered children was
  36.0 and 39.0 days, respectively.

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different outcome between HCs but not on the
type of malnutrition
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Malnutrition and HIV/AIDS

• Variable according to implementing agency so NO
  harmonized and standard care
• Screening for SAM and treatment in adults is
  practically absent in most programs
• Planned RCT in Jimma on supplementary feeding for
  patients on HAART

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Challenges

• Staff turnover
• Supply breaks
• Sharing/ selling of RUFT
• Poor recording
• Protocol breach
• High defaulter rate
• Payment for drugs

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Conclusion

• Appropriate treatment of SAM and integration to
  routine health care delivery can save many lives
• There is favorable environment Interest in
  health service managers at different level,
  motivation of health workers and mothers by the
  treatment outcome
• Quality of care has to be improved through
  constant supportive supervision, in-service
  training and strengthening pre-service training
  as long term solution

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Conclusion

• Develop local expertise by working closely with
  higher learning institutions which is crucial for
  sustainability of new initiatives, research and
  development
• There is an urgent need for more operational
  researches

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thank you