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How Well Is Ethiopia's Moderate Acute Malnutrition Program Implemented?
Tarik Taye1, Seifu Hagos Gebreyesus2, Alinoor Mohamed Farah2
1Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
Background:
The success of moderate acute malnutrition (MAM) management depends on adherence to protocol.
Objectives:
This study aimed to evaluate implementation fidelity of MAM management for children aged <5 y in Ethiopia through a retrospective chart review of 817 cases across 5 regions, representing diverse agroecologic zones.
Methods:
Data were collected from 101 health posts using systematic random sampling, and a structured checklist was used to extract data on sociodemographic status, protocol adherence, and follow-up care exposure. Data were managed digitally using Kobo Toolbox and analyzed with R version 20255.05.0, employing normality assessments, descriptive statistics, and nonparametric comparisons.
Results:
Admission protocols were well followed, with 95.7% of children admitted based on mid-upper arm circumference (MUAC) ≥11.5 cm and <12.5 cm. However, only 70.2% of children met the MUAC ≥12.5 cm discharge criteria, indicating weaker adherence at discharge. Follow-up care was limited; only 19% of children received deworming postadmission, and 38.6% of charts had incomplete deworming records. Most children (86.5%) attended the expected 3-8 visits, whereas 10.2% had >8 visits, predominantly in Afar and Sidama. Ready-to-use supplementary foods were the primary supplementary foods used in all regions. Regarding treatment duration, 84.4% of children remained in care for 3-16 wk, whereas 12.7% stayed beyond 16 wk, especially in Afar and Sidama. Target MUAC was achieved within 3-14 wk for 72.1% of children, but 22.6% required >14 wk, with prolonged recovery common in Afar (73.8% past 14 wk).
Conclusions:
Overall, admission fidelity was high, but gaps existed in discharge compliance, chart completeness, and follow-up care exposure. Regional disparities were pronounced in Afar and Sidama, where longer recovery times and higher visit frequencies were observed. Improving postadmission deworming and investigating regional differences are critical for enhancing MAM program effectiveness.
