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Quantifying the Attrition of Health System Contact into Quality-Adjusted Screening Coverage for Acute Malnutrition
Tarik Taye1, Seifu Hagos2, Samson Gebremedhin2
1Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Insights
Community Health Workers
Area of Science:
- Global Health
- Pediatric Nutrition
- Public Health Interventions
Background:
- High-quality malnutrition screening is vital for children's access to care.
- Community Health Worker (CHW) contact and screening quality are often suboptimal.
- Limited evidence exists on community-level acute malnutrition screening quality.
Purpose of the Study:
- To examine acute malnutrition screening practices in children aged 6-59 months in Ethiopia.
- To provide in-depth insights into the quality of community-based screening.
- To assess quality-adjusted screening coverage.
Main Methods:
- Community-based cross-sectional study in 6 Ethiopian regions.
- Multistage cluster sampling of 1905 children (6-59 months).
- Caregiver interviews to assess screening practices and coverage over 3 months.
Main Results:
- Only 39.3% of children were visited by a CHW in the preceding 3 months.
- Of those visited, 72% had their nutritional status checked.
- Quality-adjusted screening coverage was only 40.4% among contacted children.
Conclusions:
- A significant gap exists in CHW contact and optimal screening for acute malnutrition.
- Inadequate screening quality prevents many children from benefiting from nutritional interventions.
- Prioritizing monitoring of screening quality and performance is crucial for Ethiopian stakeholders.
Background:
High-quality screening for malnutrition is a critical entry point for children with acute malnutrition to access lifesaving nutritional care, treatment, and support. However, the contacts with Community Health Workers are suboptimal, and evidence of the quality of screening for acute malnutrition at the community level is limited.
Objectives:
This study examines screening practices for acute malnutrition among children 6 to 59 mo old to provide an in-depth insight on the quality of screening in Ethiopia.
Methods:
We used data from a community-based cross-sectional study to investigate the quality-adjusted screening coverage of acute malnutrition among children 6 to 59 mo old in 6 selected regions of Ethiopia. A multistage cluster sampling method was employed to select the study participants. A quality index was constructed using need-based variables to adjust for the quality of screening. Caregivers of the children were interviewed to ascertain child nutritional screening practices during the 3 mo preceding data collection and estimate contact coverage, crude screening coverage, and quality-adjusted screening coverage.
Results:
A total of 1905 children, 6 to 59 mo old, were enrolled in the study. Less than half (39.3%) of the children in our study were visited by a Community Health Worker in the preceding 3 mo, of which, 72% were checked for nutritional status. When the nutritional screening was adjusted for quality, only 40.4% of the children contacted had the health benefits of the nutritional screening.
Conclusions:
The study reveals a critical gap in the contact between Community Health Workers and children aged 6 to 59 mo. With only 4 of 10 children visited by Community Health Workers receiving optimal nutritional screening, many children miss the health benefits from routine nutritional screening because of inadequate screening or none at all. To close the gap, stakeholders should prioritize monitoring the quality and performance of screening for acute malnutrition in Ethiopia.
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