Poster Topical Area: Community and Public Health Nutrition
Poster Board Number: 86
Worldwide an estimated 16 million children under five are suffering from severe acute malnutrition (SAM). Pakistan bears a high burden of wasting (15.1%) among children. The objective of this study was to evaluate the impact of community-based management of SAM through Lady Health Workers (LHWs) at health house level compared with the standard CMAM program delivered at a government health facility supported by an international non-governmental organization.
We conducted a two-armed cluster-randomised controlled trial in district Dadu, Sindh Pakistan. Restricted stratified randomization was used to allocate clusters to the arms. The primary outcomes were recovery, relapse, defaulter and death. A structured pretested questionnaire was used to collect information on socio-demographics, child health and nutritional status, feeding practices, food intake and anthropometry. An independent sample t test and chi square test were used for outcome comparison across study arms.
Though the recovery rate was higher in the control arm (83.0%) than in the intervention arm (76.0 %.) (p 0.014), it was within the limits of Sphere standards. Relapse rate was almost similar across the arms with 14.6% in the intervention and 14.1% in the control arm (p 0.873). 3.8% children in the intervention and 2.5% in the control arm were defaulters. Only 1 death in the intervention and 2 deaths in the controls arms were observed. Average weight gain (g/kg/d) was 5.36 ± 5.64 in the intervention arm and 4.71 ± 5.46 in the control arm (p 0.135). Mean MUAC gain (mm/day) was 0.21 ± 0.14 in the intervention and 0.27 ± 0.19 in the control arm (p <0.0001).
Integrating SAM treatment with the regular LHW program may be a useful model to enhance early management of SAM cases in the community. However, it requires strong capacity building of LHWs through training along with close supervision and monitoring.
Key words: Severe Acute Malnutrition, LHWs, community management of acute malnutrition, facility based program, Pakistan
Funding Source: Innocent Foundation through Action Against Hunger.
Aga Khan University
Karachi, Sindh, Pakistan