Programmatic adaptations to acute malnutrition screening and treatment during the COVID-19 pandemic
Maria Wrabel1, Ronald Stokes-Walters1, Sarah King1
1Action Against Hunger USA, Washington, DC, USA.
Insights
COVID-19 adaptations to community-based management of acute malnutrition (CMAM) were generally accepted. While family mid-upper arm circumference (MUAC) screening helped, challenges with accuracy and monitoring arose. Modified criteria and reduced visits improved logistics and reduced risks.
Area of Science:
- Public Health
- Global Health
- Pediatrics
Background:
- The COVID-19 pandemic disrupted essential health services, including acute malnutrition screening and treatment for children.
- Adaptations to community-based management of acute malnutrition (CMAM) programs were implemented globally to maintain service delivery amidst transmission risks.
Purpose of the Study:
- To document practitioners' operational experiences and lessons learned from CMAM program adaptations during the COVID-19 pandemic.
- To gather qualitative insights on the acceptance and challenges associated with CMAM adaptations.
Main Methods:
- Qualitative findings from a larger mixed-methods study.
- 37 interviews with practitioners from 15 organizations across 17 countries (July 2020 - January 2021).
Main Results:
- Adaptations like family mid-upper arm circumference (MUAC) screening, modified admission/discharge criteria, modified therapeutic food dosage, and reduced follow-up visits were mostly well-accepted.
- Family MUAC addressed screening gaps but raised concerns about long-term accuracy and monitoring. Modified criteria and reduced visits streamlined logistics, improved staff workload, and reduced caregiver travel.
- Concerns persisted regarding the impact of adaptations on treatment progress and program outcomes. Most anticipated reverting to standard protocols post-pandemic.
Conclusions:
- CMAM adaptations during COVID-19 offered operational benefits but require further evidence on long-term impacts, equity, and unintended consequences.
- Rigorous, multi-year research is needed to understand the effectiveness and sustainability of these adaptations in diverse settings.
- Ensuring program quality and equity remains crucial when implementing and evaluating CMAM adaptations.
Abstract:
The COVID-19 pandemic presented numerous challenges to acute malnutrition screening and treatment. To enable continued case identification and service delivery while minimising transmission risks, many organisations and governments implemented adaptations to community-based management of acute malnutrition (CMAM) programmes for children under 5. These included: Family mid-upper arm circumference (MUAC); modified admission and discharge criteria; modified dosage of therapeutic foods; and reduced frequency of follow-up visits. This paper presents qualitative findings from a larger mixed methods study to document practitioners' operational experiences and lessons learned from these adaptations. Findings reflect insights from 37 interviews representing 15 organisations in 17 countries, conducted between July 2020 and January 2021. Overall, interviewees indicated that adaptations were mostly well-accepted by staff, caregivers and communities. Family MUAC filled screening gaps linked to COVID-19 disruptions; however, challenges included long-term accuracy of caregiver measurements; implementing an intervention that could increase demand for inconsistent services; and limited guidance to monitor programme quality and impact. Modified admission and discharge criteria and modified dosage streamlined logistics and implementation with positive impacts on staff workload and caregiver understanding of the programme. Reduced frequency of visits enabled social distancing by minimising crowding at facilities and lessened caregivers' need to travel. Concerns remained about how adaptations impacted children's identification for and progress through treatment and programme outcomes. Most respondents anticipated reverting to standard protocols once transmission risks were mitigated. Further evidence, including multi-year programmatic data analysis and rigorous research, is needed in diverse contexts to understand adaptations' impacts, including how to ensure equity and mitigate unintended consequences.
More Related Videos
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:28Chronic Kidney Disease III: Interprofessional Care
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:22Acute Kidney Injury VI: Nursing Management
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:18Chronic Kidney Disease IV: Nursing Management