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Use of collaborative learning approach for increased cure rate among children aged 6-59 months with severe wasting in
Alex Mokori1, Amos Hashaka Ndungutse2, Dinah Amongin3
1Programs, UNICEF Uganda, Kampala, Uganda amokori@unicef.org alexkmokori@gmail.com.
Insights
Quality improvement methods significantly increased the cure rate (CR) for child wasting in Uganda
Area of Science:
- Public Health
- Nutrition Interventions
- Quality Improvement Science
Background:
- Karamoja region, Uganda, faces a 10% child wasting rate, the highest nationally.
- 126 outpatient therapeutic care (OTC) sites manage severe acute malnutrition in the region.
- Existing cure rates (CR) in OTCs fall below the international benchmark of 75%.
Purpose of the Study:
- To enhance the cure rate (CR) for severe acute malnutrition in 10 outpatient therapeutic care (OTC) sites in Uganda's Karamoja region.
- The study aimed to increase CR from 74.1% to over 75% within a 13-month period.
- To evaluate the effectiveness of quality improvement (QI) methods in improving pediatric malnutrition treatment outcomes.
Main Methods:
- A 13-month study (July 2018-September 2019) in six Karamoja districts utilized the Ministry of Health QI Framework.
- Quality Improvement Teams (QITs) applied the Institute for Health Improvement (IHI) model, conducting root cause analyses and using plan-do-study-act cycles.
- Statistical analysis, including chi-squared tests, assessed cure rate associations within and between districts.
Main Results:
- The overall cure rate (CR) increased from 74.1% to an average of 80% within 13 months, exceeding the 75% target.
- Abim district reported the highest CR at 83.3%, while Kaabong had the lowest at 75.2%.
- Interventions like community follow-ups for missed appointments, supervised therapeutic food administration, and comorbidity management significantly boosted CR.
Conclusions:
- Collaborative quality improvement (QI) initiatives effectively enhanced cure rates (CR) for children with severe acute malnutrition in Karamoja.
- Sustaining these improved outcomes necessitates institutionalizing QI collaborative learning by district health offices, partners, and facility management.
- The study highlights the success of QI methods in addressing critical public health challenges in resource-limited settings.
Background:
At 10%, Karamoja region has the highest rate of child wasting in Uganda. The region has 126 outpatient therapeutic care (OTC) sites for managing children with severe acute malnutrition.
Local Problem:
Cure rate (CR) in OTC in Karamoja remains below the international standard of over 75%. The study aimed at increasing the CR in 10 OTC sites in Karamoja, from 74.1% to >75% in 13 months.
Methods:
The study commenced in July 2018, up to September 2019, in purposively selected health facilities in six districts in Karamoja. Quality improvement (QI) methods per the Ministry of Health QI Framework were applied. QI teams (QITs) tracked the outcome of the tested changes for 13 months. χ2 tests were used to assess the intrafacility and interdistrict association in CR.
Intervention:
Institute for Health Improvement (IHI) (2003) improvement model was applied in this collaborative. QITs conducted root cause analysis of CR gaps, which guided them in the development of improvement aims, changes and indicators. QITs used plan-do-study-act cycles to test and adopt the feasible changes.
Results:
CR increased from 74.1% to 78.6%, with an overall average of 80% within 13 months. Abim district had the highest CR (83.3%) and Kaabong district the lowest (75.2%). Health centre II (84.0%) had the highest CR. Assigning village health teams to follow up caregivers of children in OTC with missed appointments, allocation of village health teams and local leaders to monitor the administration of ready-to-use therapeutic food to children, and screening and treating comorbidities among children in OTC increased CR.
Conclusions:
QI methods focusing on collaborative learning increased CR among children in OTC in Karamoja. Sustaining the gains requires district health offices, partners and health facility management's commitment to institutionalise the QI collaborative learning approaches.
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