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Community-Based Therapeutic Care of Severe Acute Malnutrition in Oromiya Region, Ethio

pia by Group 1

Hoang Nguyen, Priscilla Funasani, Mengqi CHEN, Baibing MI, Jiahui DING

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Community-Based Therapeutic Care of Severe Acute Malnutrition in Oromiya Region, Ethio

pia by Group 1

Hoang Nguyen, Priscilla Funasani, Mengqi CHEN, Baibing MI, Jiahui DING

Project ProposalAchieving MDGs for Global Health

Summer School Program 2014

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Introduction to Background

Key Questions

Project Plan

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Introduction to Background

Key Questions

Project Plan

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SAM

Severe acute malnutrition (SAM), is defined as a weight-for-height measurement of 70

% or more below the median, or three SD or more below the mean National Centre for Health Statistics reference values.

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Global Malnutrition

Source: http://globalmalnutrition.wordpress.com/world-regions/

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EthiopiaCore Country Data

Population under 5 (thousands) 13,651

Birth rate (births/1000 population) 43.66

Infant mortality rate (deaths / 1,000 live births) 75

Maternal mortality ratio(2000–2007, reported)(death/100,000) 670

Primary school enrollment ratio(2000–2007, net, male/female) 74/69

% U1 fully immunized (DPT3) 73

% population using improved drinking-water sources 42

Estimated adult HIV prevalence rate (aged 15–49) (2007) 2.1

% U5 suffering moderate and severe underweight/stunting 11/47

(Source: The State of the World’s Children 2009)

8Malnutrition Prevalence in Ethiop

iaSource:Evaluation of Community Management of Acute Malnutrition (CMAM): Ethiopia Country Case Study.

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Oromiya• A population of 4,448,760 children under five

• 444,876 children (10%) are affected with SAM

• 29 hospitals, 192 health centers, 895 health stations and 1070 health posts

• 229 NGOs: 53 INGOs and 176 NNGOs

• 7.6 % sanitation coverage for water use

Source:The 2007 Population and Housing Census of Ethiopia

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East HarargeLocation of Intervention

Source: Central Statistical Agency Ethiopia's Rural Facilities and Services ATLAS 2011

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East HarargeLocation of Intervention

• First priority area with high prevalence of SAM

Limited health facilities

• 11 Existing NGOs: 4 NNGOs and 7 INGOs (Source:http://www.oarc.org.et)

• Convenient road network and 2 ariports available

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Introduction to Background

Key Questions

Project Plan

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Key Questions

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Which treatment should we choose?

F-100

• Treat SAM in hospital setting with medical complications

• Water-based• Storage needs power• 2-hours shelf life• Health workers resource• Health infrastructure res

ource• Residents accecibility to

facilities

RUTF

• Treat SAM at community setting with no medical complications (large scale)

• Oil-based• Stored at home temperat

ure• Long shelf life• Easy production tech• Flexibility and effectivene

ss• Challenges Active case finding Community participation Patent & production

BOTH HAVE SIMILAR COMPOSITION

√

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What is our general treatment like?

A combination of 2 treatments

Priority to Community-based Treatment

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How can we get RUTF?

"RUTF production in Ethiopia has been hampered by the difficulty of importing ingredients not available locally, particularly dry skimmed milk and the mineral–vitamin mix. " -- Collins, Steve

Source: Local production and provision of RUTF for the treatment of SAM

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How can we get RUTF?

Simple technology to produce RUTF

Establish partnership with local factory and farmers.

Ensure the factory and its production have quality certificate issued by government.

Patent of RUTF

Source: Local production and provision of RUTF for the treatment of SAM

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Should we pay overall attention on treatment?

Source: Severe Acute Malnutrition Strategy in the Oromiya Region, Ethiopia

• High case fatality

• Permanent developmental consequences

• Behavior problems

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Should we cover all the children in need?

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Introduction to Background

Key Questions

Project Plan

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Project Plan

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ChallengesAims Target Population

3 Phasis

PreparationPrevention

& TreatmentSustainability

Budget & Timeline

CONTENT

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A ims

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Aims

Ensure 90% severely malnourished under-5 children that are adequately managed

Achieve a malnutrition cure rate of > 80%, defaulter

rate <15% and mortality rate < 5% in TFPs (FMOH, HSDP IV, 2010)

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Target Population

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Target Population

We choose E.hararge in

Oromiya, covering 5000 children with SAM in need.

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3 Phasis

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Preparation

1 Establish partnership, especially involve the government in.

2 Material preparation

3 Volunteer recruitment and training

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Organization Flowchart

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Establish partnership1. Disseminate workshop with related stakeholders

•Local authority•RUTF private companies/factories•Local farmers•Local health facilities•NGOs•Community

2. Access the leaders of village in the community to discuss and persuade them to participate in the interventions

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Material preparation

Leaflet, brochure on malnutrition prevention

Training material on IEC skills

Equipment: weighting boards, MUAC tape

Medications

RUTF (first stage), vitamins, skimmed milk

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Volunteer recruitment and training

Prepare training materials on malnutrition problem and malnutrition preventive strategies

Recruit local health staff and volunteers

Teach health workers and volunteers within E.Hararge on malnutrition & IEC skills

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Prevention

1 Education to family members

2 Preventive service

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Education1 Teach the communities on malnutrition problem an

d how to prepare nutritious food using the available resources.

2 Identify best practices for modeling.

3 Encourage male involvement for decision making. 4 Sensitize the community on improving water , sanit

ation systems and hygiene practices .

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Preventive Service1. Provide nutrition supplements for preganent women and children

2. Vaccination for mothers and children

3. Family planning

4. Water supply and safety measures

5. Health home environment

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Treatment

1 Case Identification

2 Treatment Provision

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Treatment

Flowchart

Resource: Federal Ministry of Health and UNICEF; Ethiopia; 2009

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Sustainability1. Success of this project will attract more potential pa

rtners and other stakeholders

2. Improve the local health care system (positive cycle)

3. Local production of RUTF (Malawi suceess & farmers benefits& economy)

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EstimatedBudget

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Budget

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Timeline

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Challenges

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Challenges• Insufficient resources Money (transport costs) Human resource (health staff and volunteers) Material (RUTF manufacturing)

• Community participation

• Sustainability ( long term to follow up)

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Reference[1] A Joint Statement by the World Health Organization T W F P, The United Nations System Standing Committee on

Nutrition and the United Nations Children’s Fund. COMMUNITY-BASED MANAGEMENT OF SEVERE ACUTE MALNUTRITION[J], 2007.

[2] Africa P T. Emotional Stimulation in the Context of Emergency Food Interventions[J], 2009.

[3] Bernal C, Velasquez C, Alcaraz G, et al. Treatment of severe malnutrition in children: experience in implementing the World Health Organization guidelines in Turbo, Colombia[J]. J Pediatr Gastroenterol Nutr, 2008, 46(3): 322-8.

[4] Bhutta Z A, Ahmed T, Black R E, et al. What works? Interventions for maternal and child undernutrition and survival[J]. The Lancet, 2008, 371(9610): 417-440.

[5] Collins M K J B a S M T a T K S P B S. Probiotics and prebiotics for severe acute malnutrition (PRONUT study): a double-blind effi cacy randomised controlled trial in Malawi[J], 2009.

[6] Collins S, Dent N, Binns P, et al. Management of severe acute malnutrition in children[J]. Lancet, 2006, 368(9551): 1992-2000.

[7] Diagnostic T a I C. Ethiopia’s Infrastructure:A Continental Perspective[J], 2010.

[8] Ethiopia Central Statistical Agency M, Development O F a E. Distributive and Service Trade Survey 2008-2009 (2001 E.C)[J], 2009.

[9] Ethiopia C S a O. Ethiopia Demographic and Health Survey 2005[J], 2006.

[10] Ethiopia C S a O. Report on urban distributive trade survey[J], 2009.

[11] Ethiopia C S a O. The 2007 Population and Housing Census of Ethiopia[J], 2010.

[12] Ethiopia C S a O. Atlas of Agricultural Statistics[J], 2011.

[13] Ethiopia C S a O. The Atlas of Ethiopian Rural Facilities and Services[J], 2011.

[14] Ethiopia F M O H I. PROTOCOL FOR THE MANAGEMENT OF SEVERE ACUTE MALNUTRITION[J], 2007.

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Reference[15] Force T a H C N T. CSOs/NGOs IN ETHIOPIA Partners in Development and Good Governance[J], 2008.[16] Fund A J S B T W H O a T U N C S. WHO child growth standards and the identification of severe acute malnutrition in infants

and children[J], 2010.[17] Government of Malawai M O H, Unicef. Interim Guidelines for the Management of Acute Malnutrition in Adolescents and

Adults [J], 2006.[18] Isanaka S, Villamor E, Shepherd S, et al. Assessing the impact of the introduction of the World Health Organization growth

standards and weight-for-height z-score criterion on the response to treatment of severe acute malnutrition in children: secondary data analysis[J]. Pediatrics, 2009, 123(1): e54-9.

[19] Kapil U. Ready to Use Therapeutic Food (RUTF) in the Management of Severe Acute Malnutrition in India[J]. Indian Pediatrics, 2009, 46(5): 381-382.

[20] Kudama G. Economics of Groundnut Production in East Hararghe Zone of Oromia Regional State, Ethiopia[J], 2013.[21] Mulataa Z. Political nongovernmental organizations NGOs) and governmental companies in Ethiopia[J], 2010.[22] Nunez M O. Impact of local RUTF manufacture on farmers’ incomes in Malawi[J], 2010.[23] T. Bela Chew H N T. ASSESSMENT OF OUTPATIENT THERAPEUTIC PROGRAMME FOR SEVERE ACUTE

MALNUTRITION IN THREE REGIONS OF ETHIOPIA[J], 2007.[24] Taha A S, Mccloskey C, Prasad R, et al. Famotidine for the prevention of peptic ulcers and oesophagitis in patients taking

low-dose aspirin (FAMOUS): a phase III, randomised, double-blind, placebo-controlled trial[J]. Lancet, 2009, 374(9684): 119-25.

[25] Tariku B A. STUDIES ON CATTLE MILK AND MEAT PRODUCTION IN FOGERA WOREDA: PRODUCTION SYSTEMS, CONSTRAINTS AND OPPORTUNITIES FOR DEVELOPMENT[J], 2006.

[26] Unicef. EVALUATION OF COMMUNITY MANAGEMENT OF ACUTE MALNUTRITION (CMAM) ETHIOPIA COUNTRY CASE STUDY[J], 2012.

[27] Unicef. EVALUATION OF COMMUNITY MANAGEMENT OF ACUTE MALNUTRITION (CMAM) PAKISTAN COUNTRY CASE STUDY[J], 2012.

[28] Valerie Gatchell V F a P-R T. The sustainability of Community-based Therapeutic Care (CTC) in non-acute emergency contexts[J], 2010.

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Thank you