Dialogues in Health (Dec 2023)
The effectiveness of facility-based management of children with Severe acute malnutrition and their determinants in Jharkhand, India: A retrospective study
Abstract
Background: Children with Severe acute malnutrition (SAM) experience a high risk of disease and developmental delays contributing to large scale morbidity and mortality particularly in the developing world with existing progress inadequate to attain the Sustainable Development Goal for improved nutrition, and the cessation of all forms of undernourishment by 2030.The study objective was to assess the functioning and effectiveness of facility-based management of children with SAM in terms of their recovery (anthropometric indicators), adherence to discharge, and follow-up guidelines. Methods: This secondary data analysis obtained data from the physical patient registers of two malnutrition treatment centres (MTCs) located in the Jamtara district of Jharkhand. Information of 245 children admitted to these MTCs from April 2019-April 2020 was obtained consecutively including anthropometric outcome (weight, length, and Mean Upper Arm Circumference) measurements during the period of their admission. The primary outcome was the proportion of children who attained the recommended discharge criterion of greater than 15% weight gain at the time of discharge. Results: The mean (SD) age of the children with SAM was 1.52 (0.73) years including 55.1% females and 44.9% males. There were 38% of children had a MUAC below 11.5 cm, and 62% had a Z score for weight for height below -3SD. The mean (SD) length of admission stay at the MTCs was 17.16 (5.76) days. A statistically significant improvement in the mean weight and MUAC at discharge was found although the effect size was small (0.98 kg). Only 105 (44.3%) (n=237) children with SAM achieved recovery as per the discharge criterion requirement of ≥15% weight gain since the time of admission. The mean (SD) duration of stay of the children who recovered was 20.43 (5.64) days, being significantly higher compared to the children who failed to recover as per the weight guidelines 14.59 (4.4) days (p < 0.001). Conclusion: MTCs were effective in the management of children with SAM although the recovery rate through weight gain criterion was poor due to premature discharge and lack of follow-up suggestive of a high-burden of adverse social determinants and inadequate health system sensitization and preparedness.
