Preprint Article Version 1 This version is not peer-reviewed

Filling the Gaps for Community-Based Programs Managing Treatment and Prevention of Child Malnutrition in Non-Emergency Contexts: Results from the Rainbow Project 2015-17 in Zambia

Version 1 : Received: 1 June 2018 / Approved: 1 June 2018 / Online: 1 June 2018 (12:04:50 CEST)

A peer-reviewed article of this Preprint also exists.

Moramarco, S.; Amerio, G.; Kasengele Chipoma, J.; Nielsen-Saines, K.; Palombi, L.; Buonomo, E. Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia. Int. J. Environ. Res. Public Health 2018, 15, 1807. Moramarco, S.; Amerio, G.; Kasengele Chipoma, J.; Nielsen-Saines, K.; Palombi, L.; Buonomo, E. Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia. Int. J. Environ. Res. Public Health 2018, 15, 1807.

Journal reference: Int. J. Environ. Res. Public Health 2018, 15, 1807
DOI: 10.3390/ijerph15091807

Abstract

Background: Evaluation of nutrition programs is essential to guarantee the effectiveness of community-based management of acute malnutrition (CMAM). Methods: The Rainbow Project Supplementary Feeding Programs (SFPs) in Zambia were evaluated between years 2015-17, following implementation of new recommendations based on previous evaluations (years 2012-14). Outcomes of the program were compared with International Standards and with those of 2012-14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: Data for 900 under age 5 years malnourished children (48.8% male; mean age 19.7months ±9.9) were analyzed. Rainbow 2015-17 program outcomes met International Standards, for general malnutrition or stratified moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). When comparing with 2012-14 outcomes, better performance was noted: mortality rates were reduced by half (5.6% vs 3.1%, p = 0.01; for SAM: 12.4% vs 6.7%, p = 0.006), with significant improvement in average weight gain and mean length of stay (p<0.001), and increased awareness of HIV status (+30%; p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ < −3 at baseline (4.6; 1.3–16.1) and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Conclusion: The effectiveness of the Rainbow SFPs for child malnutrition treatment and prevention in Zambia has significantly improved after evaluation and implementation activities, with impressive outcomes which resulted in a 50% reduction in mortality.

Subject Areas

childhood malnutrition; community-based management of acute malnutrition–CMAM; moderate acute malnutrition–MAM; supplementary feeding programs–SFP; Zambia

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