Treatment of severe acute malnutrition : the positive effect of caregivers' knowledge of treatment objectives on treatment outcomes at Dadaab refugee camps, Kenya

Mbogo, Alexander M. (2017-03)

Thesis (MNutr)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY : Objective: To determine the relationship between caregivers’ knowledge of treatment objectives and the default rates of children with severe acute malnutrition (SAM) in community-based programmes. Methods: A cohort study design was used. The study was conducted in Ifo and Hagadera refugee camps in Kenya which began on 21st May, 2015 and ended on 31st July 2015. Each refugee camp contributed half of the total sample. A total of 128 children, 6–59 months old who had severe acute malnutrition and met inclusion criteria, together with their caregivers, were selected from the stabilisation centre (SC) (n = 44) and out-patient therapeutic feeding programme (OTP) (n = 84). A standardised structured questionnaire was used to collect data on caregivers’ knowledge of treatment objectives, caregivers’ perceptions of quality of care, and on defaulting. The child’s weight, height, mid-upper-arm circumference (MUAC) and length of stay were taken. Study participants were followed for a period of two months and there was no loss to follow-up. SC children who were in phase II of treatment were enrolled and followed up until they were discharged or defaulted. OTP children who were in their second weekly visit were also enrolled in the study and followed up until they were discharged or defaulted. Data was captured on Microsoft Excel and cleaned and analysed using SPSS version 17.0. A p-value of <0.05 was considered significant. Results: A total of 128 children were enrolled in the study. Their median age was 12 months and most of them were within 6–23 months of age. The average age of the caregivers in SC was 27.8 years (±5 years), while in OTP it was 27.4 years (±7.1 years). There were no defaulters. The median length of stay for SAM cases in SC was 10 days, while in OTP it was 35 days. No significant difference was found in the length of stay between SAM cases admitted with a lower MUAC of 11.4 cm and those admitted with a MUAC ≥ 11.5cm. The average weight gain rate in SC and OTP was 3.85 g/kg/day and 4.21 g/kg/day respectively. The mean score of caregivers’ knowledge of treatment objectives in SC was 52.8%, while for OTP was 58%. Most of the caregivers from Ifo refugee camp had more positive ratings and perceptions about the programme’s services than those from Hagadera refugee camp. Conclusion: The findings of this study suggest that caregivers’ knowledge of treatment objectives may greatly influence the treatment outcomes of SAM cases due to treatment compliance. In addition, caregivers’ perceptions of healthcare services provided in community-based management of acute malnutrition (CMAM) programmes may be affected greatly by their interaction with healthcare workers. Consequently, their perceptions could influence their satisfaction with CMAM services and compliance to treatment. Therefore, the delivery of CMAM services that effectively incorporate patient-centred care principles may provide a promising approach for scaling up the performance of the CMAM programmes.

AFRIKAANSE OPSOMMING : Doelwit: om die verhouding tussen ouers se kennis behandelings doelwitte en die uitval syfers van kinders met 'n ernstige akute wanvoeding (EAW) in gemeenskapsgebaseerde programme te bepaal. Metodiek: 'n Kohort studie-ontwerp is gebruik. Die studie is onderneem in Ifo en Hagadera vlugtelingkampe in Kenia tussen Junie en Julie 2015. Elke vlugtelingkamp het bygedra tot die helfte van die totale study groep. ʼn Totaal van 128 kinders, 6-59 maande oud met ernstige akute wanvoeding en wat aan die insluitings kriteria voldoen het, tesame met hul versorgers, is gekies uit die stabilisering sentrum (SS) (n = 44) en buitepasiënte terapeutiese voedingsprogram (BTV) (n = 84). 'n Gestandaardiseerde gestruktureerde vraelys is gebruik om data in te samel van versorgers se kennis aangaande behandelings doelwitte, die versorgers se persepsies van die gehalte van sorg en oor afwesig wees. Elke kind se gewig, lengte en mid-arm omtrek is geneem. Studie deelnemers is opgevolg vir 'n tydperk van twee maande en daar was geen verlies aan opvolg nie. Stabilisering sentrum kinders wat in fase II van behandeling kon deel vorm van die studie en is opgevolg totdat hulle ontslaan is of uitgeval het. Buitepasiënte terapeutiese voedingsprogram kinders wat in hul tweede weeklikse besoek kon ook deel vorm van die studie en is opgevolg totdat hulle ontslaan of uitgeval het. Data is ingelees op Microsoft Excel, en skoongemaak en ontleed met behulp van SPSS weergawe 17.0. ‘n P-waarde van <0.05 is as betekenisvol beskou. Resultate: ʼn Totaal van 128 kinders het deel gevorm aan die studie. Die gemiddelde ouderdom van die kinders was 12 maande en die meerderheid was tussen 6-23 maande oud. Die gemiddelde ouderdom van die versorgers in SS was 27.8 jaar (± 5 jaar) en 27.4 jaar (± 7.1 jaar) in die BTV groep. Geen van die kinders het tydens die studie tydperk uitgeval nie. Die mediaan tydperk van opname vir EAW gevalle in SS was 10 dae, terwyl dit in BTV 35 dae was. Geen beduidende verskil is gevind in die duurte van opname tussen EAW gevalle met 'n mid-arm omtrek van <11,4 cm en diegene toegelaat met 'n mid-arm omtrek ≥ 11.5cm. Die gemiddelde gewigstoename in SS en BTV was 3,85 g/kg/dag en 4.21 g/kg/dag onderskeidelik. Die gemiddelde punt van versorgers se kennis ten opsigte van behandelings doelwitte in SS was 52,8%, terwyl dit vir OTP 58% was. Die meerderheid van die versorgers van Ifo vlugtelingkamp het ‘n positiewe terugvoer en persepsie aangaande die dienste van die program inv vergelyking met dié van Hagadera vlugtelingkamp. Gevolgtrekking: Die bevindinge van hierdie studie dui daarop dat versorgers se kennis van behandelings doelwitte grootliks die behandeling uitkomste EAW gevalle kan beïnvloed as gevolg van behandelings toegeeflikheid. Verder mag versorgers se persepsies van gesondheidsdienste wat in gemeenskapsgebaseerde behandeling van akute wanvoeding behandelings programme grootliks beïnvloed word deur hulle interaksie met gesondheidswerkers. Gevolglik kon hulle persepsies die tevredenheid met akute wanvoeding programme beïnvloed en hulle nakoming van die behandeling.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/101401
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