Performance of Community- based
Management of Acute Malnutrition
programme and its impact on
nutritional status of children under five
years of age in Malawi. A case of
Lilongwe Rural
MSc Research Proposal
Presented by :Alice Nyasulu
Supervisor: Dr A.M Mwangi
Date: 19th April 2012
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Background Information
• Malnutrition is the major problem in
developing countries.
• Contributes over 50% of the 10 - 11
million deaths from preventable causes,
globally-PEM is the main cause
• The recommendation was to refer SAM
children to hospital to receive therapeutic
diets along with medical care-reduced
case fatality by 55%.(WHO 2010).
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Background cont’
• Recent advent of ready to use
therapeutic foods (RUTF) allowed the
management of SAM in the
community
• Malawi being one of the poor
countries it became among the first
to adopt home based approach of
treating malnourished children.
3
Problem Statement
• Since inception of Community–based
management of under five children with
acute malnutrition in Lilongwe in 2006
its impact has not been assessed.
Justification
• Implementation of CMAM involves
utilization of scares resources it is
important to determine whether the
resources spent are bringing about
expected results.
4
Study Aim
• To contribute to the improvement of the
nutritional status of under five children
in Malawi.
Study purpose
• To provide information useful in
ensuring that the programme is meeting
its objectives through re-alignment of
activities in line with the findings.
5
Main Objective
To assess performance of CMAM and its impact on the
nutritional status of children under five years in
Lilongwe rural.
Specific Objective
• To determine the socio economic and demographic
status of the study household
• To determine the trend of nutritional status of under
five children in the programme area.
• To determine the level of coverage of CMAM program
compared to programme target.
• To establish the quality of service delivery for the
programme.
• To establish whether there is an association between
the nutritional status and the socio economic status of
the household under study.
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Research Questions
• What are the social demographic
characteristics of the population under
study?
• What is the trend of the nutrional status of
under five children in Lilongwe rural?
• What type of CMAM services are being
offered in the study area?
• What is the coverage of CMAM in the study
area?
• What is the influence of social economic
status on the nutritional status of under five
children in the study area?
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Hypotheses
• The community-based management has
significantly improved nutritional status
of under-five children in Lilongwe
rural.
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LITERATURE REVIEW
2.0 LITERATURE REVIEW
2.1 History of CMAM
2.1.2 Causes of Malnutrition
2.2 Traditional Treatment of Acute Malnutrition
2.3 Community-based Management of Acute
Malnutrition
• 2.3.1 Case detection at community level
• 2.3.2 Community Mobilization
• 2.4 Knowledge Gap
•
•
•
•
•
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Knowledge Gap
.
• Although community based management
has been identified as one of effective
management of malnutrition, it has been
hit by many problems ranging from
insufficient RUTF and not being cost
effective.
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METHODOLOGY
Study site
• Lilongwe rural in the central region of
Malawi
• In four randomly selected Traditional
Authorities
Study population
• Households with children 6-59 months
• Mothers/caretakers will be the respondent
Study design
• Cross-section with retrospective component.
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Sample size determination
• Fisher et al (1991)
n= Z2 pq/d2
Z= Level of significant = 1.962
p= Prevalence of indicators= 0.061(6.1%)
q= 1-p
d2=Degree of Precision = 0.052
n = 1.962 x 0.061 (1-0.061)
0.052
n=88.01
n= 88
• Minimum sample size
• Sample size of 200
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Sampling Procedure
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Inclusion and exclusion criteria
Measuring unit
• Children from 6-56 months old.
• Beneficiaries and non beneficiaries
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Study tools and equipment
The following will be used
• Questionnaire to collect data on
– Socio – demographic
– Socio-economic
– Health workers level of skill
– Quality and quantity of equipment/ supplies
• Anthropometric equipment
- Salter Scales
-Length/height board
-MUAC tape
• Clinical observation
• Key informant-will be used to obtain qualitative data
on child care practices
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Data collection
• Recruitment of field assistants with
nutritional knowledge or hospital working
experience
• Training of the field assistants and pre-testing
of the questionnaire
• Re-calibration of scales on daily basis to
ensure data acurancy.
• Checking equipment availability and
adequacy.
• Anthropometric measurement of under five
children
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Data management and Analysis
• Data entry using SPSS computer
packages and micro-soft excel
• Data cleaning and checking of outliers
• Data analysis using SPSS computer
packages and microsoft excel
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Variables to be analysed
• Demographic characteristics
–
–
–
–
Sex and age range
Age and sex distribution
Education levels of caregivers
Main source of income
• Nutrition status of under-five children
–
–
–
–
Height
Weight
MUAC
Child in programme or not
• CMAM Services
– Flow of supply
– Equipment availability
– Knowledge and skills for service providers
• Association between socio-economic status and nutrition status.
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BUDGET
ACTIVITIES
Training
DAYS
1
1
1
1
1
UNIT COST
1,000
1,500
1,000
2,000
250
1)reseacher
2)field assistance
3)Community leaders
1
1
1
1,000
500
500
1
2
4
1,000
1,000
2,000
Survey
1) Equipment
2)reseacher
3)field Assistants
4) fuel
5)Stationary
7
7
7
7
7
1,000
2,000
1,000
2,000
2,500
3
1
3
1
1
21,000
14,000
21,000
14,000
17,500
Supervision
1)Airtickect
2)Per diem
1
3
69,700
20,500
1
1
69,700
61,500
232,450
Community
mobilization
TOTAL
ITEM DESCRIPTION
1)Enumerators
2)stationary
3)other training material
4)Reseacher
5)Food
QUANTITY TOTAL
2
2,000
1
1,500
3
3,000
1
2,000
5
1,250
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