COMMUNITY-BASED NUTRITION INTERVENTION OF SEVERE
ACUTE MALNUTRITION IN THE OROMIYA REGION, ETHIOPIA
Date：2014-7-18
Group 4 Family
GROUP 4
LI LU(李璐)
CECILIA ELIASON
CHENG YUE(程越)
LI QIUJU(黎秋菊)
LI QIXIANQI(李宪琪)
2
Outline
3
Abstract
Ethiopia has one of the highest child malnutrition rates in the world. Aim:
to reduce the burden of Severe Acute Malnutrition among under fives in
Oromiya Region of Ethiopia. Method: a quantitative and qualitative design to
assess the U5 with SAM using a community based nutrition intervention. To
determine the KAP of mothers and provide health education. The finding of
this study would be used to scale up nutritional intervention in other parts of
the country. The study hopes to develop policies to address nutritional
problems in Ethiopia.
4
Background-global
• Every year 3 million lives are loss due to undernutrition.
(UNICEF, 2012)
• Undernutrition remains a major cause of disability and
mortality. (World Bank 2010)
• It is the top cause of global burden of disease underlying
53% of deaths in children under five years. (Medhin et al. 2010)
5
Background-Africa
•
An estimated 200 million
people (children and
adults), are malnourished.
(FAO 2003)
•
More than 1/3 African
children U-5 are stunted
with physical and cognitive
challenges.
(Benson & Shekar2006)
Child Malnutrition in Africa
Under five mortality rate worldwide
6
Background- Ethiopia
Map of Ethiopia
•LEB m/f 62/65
•POD U-5 68/1000
•POD (15-60yrs) m/f
250/1000,212/1000
•Total expenditure on health
per capita (Intl $) 44
•Total expenditure on health
as % of GDP 3.8
(WHO, 2012)
7
U5M in Ethiopia
• The 6th worst country(88) in terms of
nutritional outcomes worldwid
（Ethiopia）(The Global Hunger Index 2008)
• U-5 children
underweight:34.4%(Oromiya)
• In 2013, 44% of the children U-5 were
stunted with a regional differences;
Amhara (52%), Tigray (51%),
Addis Ababa (22%)，Gambella (27%)
(Gezae & Regassa, 2013)
8
The cause of U5M in south Africa
Malnutrition is a major underlying and preventable factor in child
9
deaths under the age of five.
Current evidence
•CTC (community-based therapeutic care) was found to be relatively more cost
effective for severe acute malnutrition children in Sidama.(Asayehegn et al,2012)
•The culturally appropriate nutrition Education package based on the nutrition
triangle model effectively prevented growth faltering and malnutrition among
young children.( Swapan etal.2007)
•Community-based Health Planning and Services(CHPS) compound in Ghana is very
successful to reduce health inequalities and promote equity of health
outcomes.(Esena, 2013)
10
Conceptual framework
Social determinants(politic,econmic,culuture)
Inadequate Household Inadequate Maternal Inadequate Health
Food security
&child Health
service
insufficient
dietary intake
Baseline
Factors
child disease
severe acute malnurtrition（6-59months）
Community-based intervention
Post-intervention
evaluation
Identificed case
CHNPS
Reduce the SAM
11
What is SAM?
Severe acute malnutrition is defined by a
very low weight for height (below -3z scores of
the median WHO growth standards), by visible
severe wasting, or by the presence of nutritional
oedema.
Source:WHO:http://www.who.int/nutrition/topics/malnutrition/en/
12
Severe Acute Malnutrition Screening tool
weight-for-height: WHO and UNICEF recommend the use of a
cut-off for weight-forheight of below -3 standard deviations
(SD)
of the WHO standards to identify infants and children as having
SAM.
Reason：
1.A highly elevated risk of death.
2.Faster recovery.
3.In a well-nourished population, there are virtually no children
below -3 SD (<1%).
13
Aims and Objectives
OBJECTIVES
SPECIFIC OBJECTIVE
Aims:To
reduce
the
burden
severe
acute
malnutritionn
Baseline
•To assess
the number
of U-5of •To
determine
the nutritional
situation of U-5
with SAM
•Identify SAM among 6-59months
among under
fives
in
Oromiya
Region
of Ethiopia.
•To determine the KAP of
•To determine the KAP of mothers towards
mothers on child nutrition
•To identify nutritional policies
in the region
child nutrition
Implementation
•To implement communitybased nutrition intervention
among U-5
•To provide health education
on child nutrition to mothers
•To provide RUTF to SAM children
•To train CHN & CHV to monitor and distribute
administration of RUTF
•To measure the effect of the treatment of
RUTF among U-5
•To improve the mothers’knowledge on child
nutrition
Evaluation
•To evaluate the effects of
community-based nutrition
intervention
•To compare the nutrition status of SAM U-5
before and after the CBNI
•To examine KAP of mothers after HE
•To determine effects of nutritional policy
14
Hypotheses
Hypotheses1
Nutrition condition of Children(6-59months) with
SAM will improve after the RUTF intervention.
Hypotheses2
KAP of mothers will improve after health education.
Aims and Objectives
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Methods-design
•Design – Cross-sectional study(before and after intervention)
Quantitative Survey to determine the number of SAM and
the
nutrition status of U-5; KAP of mothers by use of
questionnaire.
Qualitative Interview of policy makers and community
leaders
16
Methods-study preparation
Convening the research team
Recuritment study subject
Target population
Sampling
Who do it?
SAM children(6-59months)
General survey
(Screening in
baseline)
Community health worker;
Research assistance.
Mother
Convenient Sampling
Community health worker;
Research assistance.
17
Methods-study preparation
Tool preparation
•WHO nutrition screening tool
•Child nutrition status questionnaire
•KAP questionnaire for mother
•Interview guide for policy maker
18
Methods-Intervention Framework
Baseline survey
Demographic of U-5 child and mother; KAP of mother
Nutrition situation; Qualitative interview for policy
maker;Health status; et al
SAM children
(6-59months)
Intervention
Mothers
Community
&Policy maker
Post-intervention
evaluation
RUTF
Health education;
Maternal health;
CHNPS
Demographic of child(SAM child) of mother;KAP of
mother Nutrition situation of child;Health status;
et al
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Intervention
Community-based nutrition intervention
The community-based approach involves timely detection of
severe acute malnutrition in the community and provision of
treatment for those without medical complications with ready-to-use
RUTF
therapeutic foods or other nutrient-dense foods at home.
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Intervention-target population
Policy Maker
•Population of U5 in Ethiopia-1,1883
•U-5 in Omoriya-4, 723
•U-5 in Omoriya with SAM-600 ( est. from EHDS,2011)
•Mothers(WRA)- estimated from SS of U-5
Mother
SAM
（6-59months）
•Policy makers- inteviews
Community
21
Intervention-target population
Target population
Inclusion criteria
Exclusion criteria
SAM children
•All children aged 6-59 months
•Born and living in the Omoriya province, including
those in nursery
•Children aged ≥60 months
•All children who are on
admission with other
medical condition other than
nutritional problems
Mothers
•Living with children aged 6-59 months
•Women in the Reproductive Age (WRA),Female
Adolescents
N/A
Community
•Involve community leaders and opinion leaders in
decision making.
• Family heads in the community
N/A
Policy maker
•Unit assembly representative
•District chief executive
• Regional administration officers
•Government appointees from various sectors
(Health, Local government, Food and Agriculture,
Education etc)
N/A
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Intervention-SAM U5 CHILDREN
Intervention
Provide RUTF
• Eight weeks
• 10-15kg per person
Vaccination
Exclusive Breastfeeding
Management of SAM
• Therapeutic zinc for diarrhoea
• WASH
• Feeding in diarrhoea
• Malaria prevention in children
• Deworming in children
• Obesity prevention
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Intervention-Mother
Health education
• Nutrition
• Child growth
• Nutrition in pregnancy
• Food security
• Diet balance
• Breastfeeding
As volunteer
24
Intervention-community
Intervention
Recurit volunteer
•Public health worker
•Mother
CHNPS Compound
•Community Health Nurse
•Community volunteer
•Training volunteer
•Identified the case
•Distribute RUTF
•Monitor
25
Data Analysis
•SPSS version 17
•Descriptive statistic. Eg. Frequency, means, SD,etc
•T-test for comparison
•Logistic analysis
26
Budget
ITEM
QUANTITY
PERSONNEL
UNIT
COST
DAYS
TOTAL
COST
$
SUPPLIES/STATIONE
RY
Health Educ. Materials
PI
5
50
40
10000
Co-investigators
5
40
40
8000
Research Assistants
20
10
40
8000
Printer ink
10
25
5
1250
Laptop(notebook size)
10
700
1
7000
stationery(pen. Pencil)
10
20
2
400
A4 sheet
50
10
1
500
Training
Field workers
12
5
40
2400
Community Health
Nurses
24
10
40
9600
Communication/Phone
calls
support staff
6
5
40
1200
Sub-total
Community
volunteers
24
10
40
9600
feeding
96
15
20
28800
TOTAL
Sub-total
10%total as
Miscellaneous
TRANSPORT:
Phone calls
fuel
100
1
40
0
500
1
5
2500
4000
103250
Report writing
PERSONNEL
10
100
10
10000
subregions
TOTAL
10
1
1
1032500
27
1,032.50
Reference
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Generation, page 62 , UNICF , Save the Chidren’s Vision for a post-2015 framework Ending Poverty.
2. John Isaac ,et al.2012. “Undernutrition remains a major cause of disability and Mortality.” Global Monitoring Report
2012,page 21,World Bank, Food Prices, Nutrition, and the Millennium Development Goals.
3. Medhin ，et al. 2010.”It is the top cause of global burden of disease underlying 53% of deaths in children under five
years.” Huffpost Health Living , page 79-84,The Global Burden of Disease and 'Big Science'.
4. 2003.“An estimated 200 million people (children and adults), are malnurtrion, increased by almost 20 percent since the
early 1990s.” FAO,FAOSTAT 1963-2003.
5. Benson , Shekar , et al. 2006 .”More than 1/3 African children U5 are stunted with physical andcognitive challenges. “
paper23，UNICEF，Child nutrition interactive dashboard.
6. 2012 . “LEB m/f;62/65;POD U5 68/1000;POD (15-60yrs) m/f ;250/1000,212/1000 Total expenditure on health; per capita
(Intl $) 44;Total expenditure on health;as % of GDP 3.8.”; page 56-67 , WHO , Concessional Finance and Global
Partnerships.
7. 2008. “U5 children underweight:34.4%(Oromiya) The 6th worst country(88) in terms of nutritional outcomes worldwide.
（Ethiopia）” page 8- 10,The Global Hunger Index.
8. Gezae ,Regassa ,et al. 2013. “In 2013, 44% of the children U5 were stunted with a greater regional differences Amhara
(52%), Tigray (51%), Addis Ababa (22%)，Gambella (27%).“ page 28-32 , Nutritional status of children under five years of
age inShire Indaselassie, North Ethiopia:Examining the prevalence and risk factors.
9. Agarwal. 2012.“Malnutrition is a major underlying and preventable factor in child deaths under the age of five.” page 5-6 ,
Ending Preventable Child Deaths: A Little More Effort Could Get the Job Done
10. 2006. “Severe acute malnutrition is defined by a very low weight for height (below -3z scores of the median WHO growth
standards), by visible severe wasting, or by the presence of nutritional oedema. “ Severe Acute Malnutrition , page1-4 , WHO,
nutrition experts take action on malnutrition.
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