Background: Funds for community-based management of acute malnutrition (CMAM) programs are short-term in nature. CMAM programs are implemented in countries with weak policies and health systems and are primarily funded by donors. Beyond operational expansion, their institutionalisation and alignment with governments' priorities are poorly documented. The study aimed to identify pathway opportunities and approaches for horizontal and vertical scaling up of CMAM programs in South Sudan.
Methods: The study was conducted in South Sudan between August and September 2021 using an online qualitative survey with 31 respondents from policy and implementing organisations. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework guided the study's design. It was self-administered through the Qualtrics platform. We used Qualitative Content Analysis supported by the Nvivo coding process. A deductive a priori template of codes approach was complemented by a data-driven inductive approach to develop the second level of interpretive understanding.
Results: Findings from the study demonstrate that the emphasis of CMAM programs was horizontal scaling up, characterised by geographic distribution and coverage as well as operational expansion. Main challenges have included unsustainable funding models, the inadequacy of existing infrastructure, high operational costs, cultural beliefs, and access-related barriers. Factor impacting access to CMAM programs have been geographical terrains, safety, and security concerns. Vertical scaling up, which emphasises institutional and ownership strengthening through a sound policy, regulatory, and fiscal environment, received relatively little attention. Nutrition supplies are not part of the government's essential drug list and there is limited or no budgetary allocation for nutrition programs by the government in national budgets and fiscal strategies. Factors constraining vertical scalability have included weak government systems and capacity, a lack of advocacy and lobbying opportunities, and an apparent lack of exits strategies.
Conclusion: Addressing the scalability problems of CMAM programs in South Sudan demands a delicate balancing act that prioritises both horizontal and vertical scalability. Government and political leadership that harness multidisciplinary and multi-sectoral coordination are required. There is a need to increase policy commitment to malnutrition and associated budgetary allocation, emphasise local resource mobilisation, and ensure financial sustainability of integrating CMAM programs into the existing health and welfare system.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9442594 | PMC |
http://dx.doi.org/10.1186/s13690-022-00934-y | DOI Listing |
Ig Sanita Pubbl
September 2024
Helen Keller International, Department of Nutrition, Yaounde, Cameroon.
Introduction: The security crisis caused by the Islamic sect Boko Haram, coupled with arid climatic conditions and a context of poverty, has preyed on populations in the far north of Cameroon, exacerbating malnutrition rates among children under five years old. New evidence has shown that many children with moderate acute malnutrition (MAM) can be treated in their communities (CMAM) without having to be admitted to a health center or therapeutic feeding center. The purpose of our study was to identify factors that may lead to beneficiary dropout in a CMAM program in four health districts in the far north of Cameroon.
View Article and Find Full Text PDFMatern Child Nutr
October 2024
International Rescue Committee, New York, New York, USA.
A simplified, combined protocol admitting children with a mid-upper-arm circumference (MUAC) of <125 mm or oedema to malnutrition treatment with ready-to-use therapeutic food (RUTF) uses two sachets of RUTF per day of those with MUAC < 115 mm and/or oedema and one sachet of RUTF per day for those with MUAC 115-<125 mm. This treatment previously demonstrated noninferior programmatic outcomes compared with standard treatment and high recovery in a routine setting. We aimed to observe the protocol's effectiveness in a routine setting at scale, in two health districts of the Central African Republic through an observational cohort study.
View Article and Find Full Text PDFFront Nutr
February 2024
US Centers for Disease Control and Prevention, Atlanta, GA, United States.
Introduction: Nutrition program modifications occurred globally in response to the COVID-19 pandemic. Within community management of acute malnutrition (CMAM), community screenings for acute malnutrition were replaced by caregivers monitoring child mid-upper arm circumference (MUAC), but questions remain about different MUAC tapes' performance and acceptability for caregiver use.
Methods: The study was conducted in Central Equatoria and Warrap States, South Sudan, between March 2022 and January 2023.
Front Public Health
January 2024
Department of Pediatric Nursing, St. Paul Millennium Medical College, Addis Ababa, Ethiopia.
Introduction: Undernutrition is a major health concern in many developing countries, and is one of the main health problems affecting children in Ethiopia. Although many children experience multiple relapses following the management of severe acute malnutrition, it is scarcely studied in Ethiopia.
Methods: A community-based cross-sectional study was conducted in Dessie, Kombolcha, and Haik towns among 6-59-month-old children enrolled and discharged from community-based acute malnutrition management (CMAM).
Matern Child Nutr
April 2024
Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!