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A mixed methods feasibility study of the Kusamala Program at a nutritional rehabilitation unit in Malawi

Allison I Daniel1,2,3, Meta van den Heuvel1,4,5, Melissa Gladstone6

  • 11Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario Canada.

Pilot and Feasibility Studies
|September 28, 2018
PubMed

Insights

The Kusamala Program, integrating nutrition, WASH, and stimulation, shows feasibility for caregivers of children with severe acute malnutrition (SAM). High engagement and adherence were observed, paving the way for effectiveness trials.

Area of Science:

  • Pediatrics
  • Global Health
  • Nutrition Science

Background:

  • Children with severe acute malnutrition (SAM) in nutritional rehabilitation units (NRUs) face significant risks for poor developmental and nutritional outcomes.
  • The Kusamala Program is a novel, integrated counseling intervention for primary caregivers of children with SAM, encompassing nutrition, water, sanitation, and hygiene (WASH), and psychosocial stimulation.

Purpose of the Study:

  • To evaluate the feasibility of implementing the Kusamala Program within an NRU setting.
  • To assess the developmental outcomes in children with SAM six months post-inpatient treatment.

Main Methods:

  • A mixed-methods approach was employed, including an internal pilot trial of the first 30 children and caregivers.
  • Qualitative data were gathered through focus group discussions and in-depth interviews with 12 hospital staff members, including NRU nurses.

Main Results:

  • High participant engagement (100%) and caregiver adherence (87%) to the Kusamala Program were achieved.
  • Identified barriers included perceived program value, competing ward activities, and staff shortages.
  • Enablers comprised staff engagement, motivation, and refresher training.

Conclusions:

  • The Kusamala Program is feasible for implementation in a real-world NRU setting.
  • Further evaluation through a full cluster-randomized controlled trial is warranted to determine the program's effectiveness.
Abstract

Keywords:
Child developmentIntegrated interventionsNutritionPsychosocial stimulationSevere acute malnutritionWASH

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