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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)
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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