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Challenges in Implementing the Integrated Community-Based Outpatient Therapeutic Program for Severely Malnourished
Elazar Tadesse1,2, Eva-Charlotte Ekström3, Yemane Berhane4
1Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala SE-75185, Sweden. elazar.balla@kbh.uu.se.
Insights
Implementing community-based outpatient therapeutic programs for severe acute malnutrition faces challenges. Inconsistent ready-to-use therapeutic food (RUTF) distribution and caregiver perceptions of RUTF sales hinder effective treatment in southern Ethiopia.
Area of Science:
- Public Health
- Nutrition Science
- Pediatrics
Background:
- Severe acute malnutrition (SAM) treatment relies on Community-based Outpatient Therapeutic Programs (C-OTP) using ready-to-use therapeutic foods (RUTFs).
- Effective implementation of C-OTP is crucial for child survival in resource-limited settings.
Purpose of the Study:
- To identify challenges in critical C-OTP implementation steps.
- To understand caregivers' perceptions of service delivery within C-OTP.
Main Methods:
- Cross-sectional study involving 1048 caregivers and 175 Health Extension Workers (HEWs) in southern Ethiopia.
- Data collection through home visits with caregivers and interviews with HEWs.
- Analysis of program admission, follow-up, and exit data.
Main Results:
- Only 46.6% received adequate RUTF and 19.3% received antibiotics on admission.
- Uninterrupted RUTF provision occurred in 34.9% of participants.
- High rates of perceived RUTF diversion (42.9% caregivers, 37.1% HEWs) and inappropriate program exits (60.3%).
Conclusions:
- Inadequate RUTF provision, lack of antibiotics, and improper program exits are significant C-OTP constraints.
- Addressing these challenges requires increased resources, regular provider training, and improved supervision.
- Ensuring consistent RUTF supply and appropriate program management is vital for saving lives.
Abstract:
Currently, treatment of uncomplicated severe acute malnutrition is managed in the integrated Community based Outpatient Therapeutic Program (C-OTP) using ready-to-use therapeutic foods (RUTFs). The aim of this study was to determine challenges in implementing the critical steps in C-OTP and caregivers' perceptions of service provision in southern Ethiopia. A total of 1048 caregivers of children admitted to the OTP and 175 Health Extension Workers (HEWs) from 94 selected health posts were included in the study. Program admission, follow-up and exit information was collected from caregivers during home visits. HEWs were interviewed at their respective health posts. Only 46.6% (481/1032) were given the recommended amount of RUTF and 19.3% (196/1015) were given antibiotics on admission. During C-OTP participation 34.9% (316/905) had uninterrupted provision of the recommended amount of RUTF. Of the children who left the program, 220/554 (39.7%) exited the program in line with the national recommendation. Caregivers (42.9% (394/918) and HEWs (37.1%, 62/167) perceive that RUTFs were being sold as a commodity. Inadequate provision and unintended usage of RUTFs, lack of antibiotics and inappropriate exit from the program were major constraints. For successful saving of lives, adequate resources must be allocated, and providers must be trained regularly, and supervised properly.
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