Assessing the efficacy of acute malnutrition management of Ghanaian children from 0 to 59 months at three nutrition rehabilitation sites in the Ashanti Region

Great potentials needed to build up societies are lost when children are affected with malnutrition at early stages of life. Prevention and management of this condition are therefore highly important. An important reason behind failure of malnutrition management is limited knowledge and competency of health professionals. In Ghana, there is paucity of data on performance (mortality, default and recovery rates) of malnutrition management programmes for acute malnutrition at different centers across the country and how that is associated with compliance to management protocols. The study was therefore undertaken to determine whether the management plans in existence are yielding results based on the Global Sphere Standards. A retrospective study was conducted at three nutrition rehabilitation sites in the Ashanti Region namely the Komfo Anokye Teaching Hospital (KATH), Agogo Presbyterian Hospital (APH) and Agogo CMAM center (OPC C). Records of 100 children from 0 to 59 months, who were managed for acute malnutrition at the sites from 1st January to 31st December 2013 were retrieved. Data on socio-demographic characteristics, anthropometric measurements, feeds offered, complications, recovery, length of stay, mortality and defaulters were collected. Questionnaires were also served to staff such as nutritionists, doctors and nurses who collaborate in treating malnutrition to assess their level of knowledge and competencies in the management of acute malnutrition. Key informant interviews were further organised with a key staff at each treatment site to find out what goes into the management of malnourished children at the various centers. Based on the anthropometric assessment and complications a child presents with, the fellow received either In-Patient Care (IPC) or Out Patient Care (OPC). 100 children and seven health care personnel were involved in the study. Majority of the children (92.9%) were from 6 to 59 months while minority (7.1%) were 0 to 5 months old. Majority of the children (92%) had Severe Acute Malnutrition (SAM) while 8% had Moderate Acute Malnutrition (MAM). On discharge at IPC, there was a significant difference (p<0.01) between the weights gained at discharge and weights noted on admission. At OPC, there was also a significant difference (p<0.05) between weights gained at discharge and the weights recorded on admission. Furthermore at IPC, recovery rate stood at 82.6%, mortality rate was 11.6% while defaulter rate was 5.8%. At OPC, recovery rate was 21.4%, defaulter rate was 71.4%, non-response rate was 7.2% and no death was recorded. The highest mean score on the competency assessment was 69.5% by the KATH staff followed by APH staff with 63.0%. In conclusion, in comparison with the Global Sphere Standards, it was identified that management of acute malnutrition met recommended standards in terms of recovery and defaulter rates at IPC. On the other hand, the high defaulter rate and low recovery rate observed at OPC calls for serious attention. The results of the competency and knowledge level assessment indicated that most of the staff of the treatment centers (both IPC and OPC) who were assessed had very good knowledge levels about management of acute malnutrition. This knowledge level had a good effect on the services given at IPC’s. However this same appreciable level of knowledge particularly of OPC staff should be properly translated into practice to achieve greater positive results at the OPC’s.

Source: KNUST