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Treatment of severe acute malnutrition Experience from developmental context Jimma, Ethiopia

Treatment of severe acute malnutrition Experience from developmental context Jimma, Ethiopia. Tsinuel Girma Asst professor of Pediatrics and Child Health Jimma University Mar 2008 (2000). Child health indicators. Current U5MR trend Vs MDG trend.

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Treatment of severe acute malnutrition Experience from developmental context Jimma, Ethiopia

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  1. Treatment of severe acute malnutritionExperience from developmental context Jimma, Ethiopia TsinuelGirma Asst professor of Pediatrics and Child Health Jimma University Mar 2008 (2000)

  2. Child health indicators

  3. Current U5MR trend Vs MDG trend

  4. 500,000 under-5 dying each yearRanking 6th in the world 72 % preventable f Other, 2% Measles, 4% AIDS, 1% Neonatal, 25% Malnutrition57% Diarrhea, 20% HIV/AIDS11% Malaria, 20% Pneumonia, 28%

  5. Nutritional Status of Children Under Age Five

  6. Key interventions selected for targeted conditionNATIONAL STRATEGY FOR CHILD SURVIVAL IN ETHIOPIA ,2005

  7. In-patient treatment- hospital based • Opened as part of pediatric in-patient service (Feb 2004) • Maximum capacity of 30 patients • Staff : Feeders, nurses ,interns ,residents and consultants • Implementation of national protocol • Open 24 hrs

  8. Achievements

  9. Disciplined treatment, improved practicum set-up, new outlook about treating SAM and interest in nutrition related research

  10. More than 1350 patients treated so far most with co-morbidities (TB/HIV) • Death Rate < 6% • ARWG ~ 15g/kg/d • ALOS 4 weeks

  11. Observed and expected deaths from Jimma TFUusing Prudhon Index

  12. Out- Patient Treatment • Context • In 5 Health centers using RUTF (Dec 2005) • Community mobilization and screening • MOH is primarily responsible • UNICEF provides RUTF and antibiotics • Concern – Ethiopia: training • Jimma University- Department of Pediatrics and Child Health

  13. Performance Post-training follow –up, after 2 months in nine HCs showed • Implementation within 34days (20-58) • Enthusiastic health workers • Good acceptance by mothers and caregivers (also demonstrated in another study) But • Poor adherence to protocol ( one in five) • Poor medical recording • No proper evaluation of appetite – (field tested )

  14. Types of malnutrition on admissionn=324,four health centers

  15. Treatment outcome

  16. Outcome • RWG forrecovered children was 6.0 g/ kg/d and no difference between types of malnutrition • RWG for defaulters < 5g/kg/d • Length of stay for allrecovered children was 36.0 and 39.0 days, respectively.

  17. different outcome between HCs but not on the type of malnutrition

  18. Variable according to implementing agency so NO harmonized and standard care Screening for SAM and treatment in adults is practically absent in most programs Planned RCT in Jimma on supplementary feeding for patients on HAART Malnutrition and HIV/AIDS

  19. Challenges • Staff turnover • Supply breaks • Sharing/ selling of RUFT • Poor recording • Protocol breach • High defaulter rate • Payment for drugs

  20. Conclusion • Appropriate treatment of SAM and integration to routine health care delivery can save many lives • There is favorable environment: Interest in health service managers at different level, motivation of health workers and mothers by the treatment outcome • Quality of care has to be improved through constant supportive supervision, in-service training and strengthening pre-service training as long term solution

  21. Conclusion … • Develop local expertise by working closely with higher learning institutions which is crucial for sustainability of new initiatives, research and development • There is an urgent need for more operational researches

  22. thank you

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