How Well Is Ethiopia's Moderate Acute Malnutrition Program Implemented?

Area of Science:

• Public Health
• Pediatrics
• Nutrition Science

Background:

• Effective management of moderate acute malnutrition (MAM) is crucial for child health outcomes.
• Adherence to established protocols is a key determinant of success in MAM interventions.

Purpose of the Study:

• To evaluate the implementation fidelity of moderate acute malnutrition (MAM) management protocols for children under five years old in Ethiopia.
• To identify areas of high adherence and gaps in protocol implementation across diverse agroecologic zones.

Main Methods:

• Retrospective chart review of 817 cases of MAM management across five Ethiopian regions.
• Data collected from 101 health posts using systematic random sampling and a structured checklist.
• Analysis involved descriptive statistics and nonparametric comparisons using R software.

Main Results:

• High adherence to admission criteria (95.7% based on mid-upper arm circumference [MUAC] ≥11.5 cm and <12.5 cm).
• Lower adherence to discharge criteria (70.2% met MUAC ≥12.5 cm).
• Limited follow-up care observed, with only 19% receiving deworming and significant chart incompleteness (38.6%).
• Regional variations noted, with Afar and Sidama showing longer recovery times and higher visit frequencies.

Conclusions:

• While MAM admission protocols demonstrate high fidelity, significant gaps exist in discharge compliance and follow-up care, including deworming.
• Pronounced regional disparities in treatment duration and recovery necessitate targeted interventions.
• Improving deworming practices and addressing regional differences are critical for enhancing MAM program effectiveness in Ethiopia.