Effectiveness of Out-patient Therapeutic Program on Nutrition among Under Fives: A Retrospective Study of Kisumu East District, Kenya
Outpatient Therapeutic Program (OTP) has been implemented with great success. Monitor ing and evaluation against program objectives is integral. This study aimed to assess effectiveness of OTP program in Kisumu East District and identify factors influencing its effectiveness.In a retrospective longitudinal study targeting malnourished child ren 6–59 months registered in OTP, information on type of malnutrition, HIV status, cure rate, defaulter rate, death rate, non -response, average weight gain and Average Length of Stay (ALOS) in the program were abstracted from hospital records of 420 eligi ble children between January to December 2009; selected by systematic random sampling. Proportions of Marasmus, Kwashiorkor, and HIV were determined. Proportions of outcomes were compared against Sphere standards to assess effectiveness. Associations between type of malnutrition and: HIV status, gender, age and Mid Upper Arm Circumference (MUAC) were determined using regression analysis. From the study findings, prevalence of Marasmus (67.4%) was higher than prevalence of Kwashiorkor (31.2%). Children cured were 54%, 3.3% died, 22.6% defaulted while non -responders were 0.7%. ALOS was 39 days and rate of weight gain 4.8g/kg/day. Regression analysis showed: MUAC and HIV status influenced type of malnutrition, low MUAC increased the chances of dying by 50% (CI 0.302 - 0.944 p=0.031) and each cm increase in MUAC reduced rate of weight gain by 0.8g/kg (CI -1.483 - -0.117 p=0.022). Increase in rate of weight gain increased cure rate by 8% (CI 1.024 - 1.15 p=0.006). The program was effective in achieving low death rates, ALOS and rate of weight gain. High defaulter rate may have obscured true death and cure rates. Factors contributing to high defaulter rates should be investigated and addressed to improve program effectiveness
and outcomes within a Community -based T herapeutic Care (CTC) program to treat severe acute malnutrition in Malawi: A descriptive study. BMC Infect Dis 8, 106.
Belachew, T ., & Nekatibeb, H. (2007). Assessment of Out Patient T herapeutic Program for Severe Acute Malnutrition in three regions of Ethiopia. East African Medical Journal 84 (12).
Bunn, J., T hindwa, M. & Kerac, M. (2009). Features associated with underlying HIV infection in severe acute childhood malnutrition: A cross sectional study. Malawi Med J 21, 108-12.
Collins, S., Dent, N., Binns, P., Bahwere, P., Sadler, K. & Hallam, A. (2006a). Management of severe acute malnutrition in children. Lancet 368, 1992-2000.
Collins, S., Sadler, K., Dent, N., Khara, T., Guerrero, S., Myatt, M., Saboya, M. & Walsh, A. (2006b). Key issues in the succ ess of community-based management of severe malnutrition . Food Nutr Bull 27, S49-82.
Fanzo, J., Pronyk, P., Dasgupta, A., T owle, M., Menon, V., Dasgupta, A., Veena, M., Menon, V., Denning, G., Zycherman, A., Flor, R. & Roth, G. (2009). An Evaluation of Progress Toward the Millennium Development Goal One Hunger Target: A country-level, food and nutrition security perspective. World Food Program, 1-74.
Fergusson, P., Chinkhumba, J., Grijalva-Eternod, C., Banda, T ., Mkangama, C.& Tomkins, A. (2009). Nutritional recovery in HIV-infected and HIV-uninfected children with severe acute malnutrition. Arch Dis Child 94, 512-6.
Fergusson, P. & T omkins, A. (2009). HIV prevalence and mortality among children undergoing treatment for Severe Acute Malnutrition in Sub-Saharan Africa: A systematic review and meta-analysis. Trans R Soc Trop Med Hyg 103 , 541-8.
Friedman, J.F., Kwena, A.M., Mirel, L.B., Kariuki, S.K., T erlouw, D.J., Phillips-Howard, P.A., Hawley, W.A., Nahlen, B.L., Shi, Y.P. & Kuile, F.O. (2005). Malaria and Nutritional status among pre -school children: Results from cross-sectional surveys in Western Kenya. Am J Trop Med Hyg 73, 698-704.
Hamidu, J.L., Salami H.A., Ekanem A.U. & Hamman, L. (2003). Prevalence of Protein—Energy Malnutrition in Maiduguri,
Nigeria African Journal of Biomedical Research, 6 , 123 – 127
Heikens, G.T ., Bunn, J., Amadi, B., Manary, M., Chhagan, M., Berkley, J.A., Rollins, N., Kelly, P., Adamczick, C., Maitland, K. & T omkins, A. (2008). Case management of HIV-infected Severely Malnourished children: Challenges in the area of highest prevalence. Lancet 371, 1305-7.
Ismail, S., Immink, M., Mazar, I. & Nantel, G. (2003). Community-based food and nutrition program: What makes them successful:A review and analysis of experience. Rome; FAO of the United Nations and Food and Nutrition Division., 1 -74.
Kenya National Bureau of Statistics (KNBS) and ICF Macro. (2010). Kenya Demographic and Health Survey 2008 - 09. Calverton, Maryland: KNBS and ICF Macro.
Latham, M.C. (1997). Human nutrition in the developing world. Food and Nutrition Series - No. 29. FAO
Ministry of Medical Servises & Ministry of Public Health and Sanitataion (2010). Handbook. Intergrated Management of Acute Malnutrition
Myatt, M., Khara, T. & Collins, S. (2006). A review of methods to detect cases of severely malnourished children in the community for their admission into community-based therapeutic care programs. Food Nutr Bull 27, S7-23.
Sadler, K. (2007). Community-based Therapeutic Care: Treating Severe Acute Malnutrition in Sub -Saharan Africa. Phd T hesis submitted to University College London, London.
Sadler, K., Bahwere, P., Guerrero, S. & Collins, S. (2006). Community-based therapeutic care in HIV-affected populations. Trans R Soc Trop Med Hyg 100, 6-9.
Save the Children, (2007). Emergency Health and Nutrition Forum . Emmergency Nutrition Portfolio, 1 -24.
Sphere Project (2004). Humanitarian Charter and Minimum Standards in Disaster Response. Sphere Project, Geneva, Switzerland,103-202.
T hurstans, S., Kerac, M., Maleta, K., Banda, T. & Nesbitt, A. (2008). HIV prevalence in severely malnourished children admitted to nutrition rehabilitation units in Malawi: Geographical & seasonal variations A cross-sectional study. BMC Pediatr 8, 22.
UNICEF (2012). Draft Report: Evaluation of Integrated Management of Acute Malnutrition (Imam) Kenya Country Case Study