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Date ： 2014-7-18

COMMUNITY-BASED NUTRITION INTERVENTION OF SEVERE ACUTE MALNUTRITION IN THE OROMIYA REGION, ETHIOPIA. Date ： 2014-7-18. Group 4 Family. GROUP 4 LI LU( 李璐 ) CECILIA ELIASON CHENG YUE( 程越 ) LI QIUJU( 黎秋菊 ) LI QIXIANQI( 李宪琪 ). 2. Outline. 3.

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Date ： 2014-7-18

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  1. COMMUNITY-BASED NUTRITION INTERVENTION OF SEVERE ACUTE MALNUTRITION IN THE OROMIYA REGION, ETHIOPIA Date：2014-7-18

  2. Group 4 Family GROUP 4 LI LU(李璐) CECILIA ELIASON CHENG YUE(程越) LI QIUJU(黎秋菊)LI QIXIANQI(李宪琪) 2

  3. Outline 3

  4. Ethiopia has one of the highest child malnutrition rates in the world. Aim: to reduce the burden of Severe Acute Malnutrition among under fives in Oromiya Region of Ethiopia. Method: a quantitative and qualitative design to assess the U5 with SAM using a community based nutrition intervention. To determine the KAP of mothers and provide health education. The finding of this study would be used to scale up nutritional intervention in other parts of the country. The study hopes to develop policies to address nutritional problems in Ethiopia. Abstract 4

  5. Every year 3 million lives are loss due to undernutrition. (UNICEF, 2012) Undernutrition remains a major cause of disability and mortality.(World Bank 2010) It is the top cause of global burdenof disease underlying 53% of deaths in children under five years.(Medhin et al. 2010) Background-global 5

  6. Under five mortality rate worldwide Background-Africa • An estimated 200 million people (children and adults), are malnourished. (FAO 2003) • More than 1/3 African children U-5 are stunted with physical and cognitive challenges. (Benson & Shekar2006) Child Malnutrition in Africa 6

  7. Map of Ethiopia Background- Ethiopia • LEB m/f 62/65 • POD U-5 68/1000 • POD (15-60yrs) m/f 250/1000,212/1000 • Total expenditure on health per capita (Intl $) 44 • Total expenditure on health as % of GDP 3.8 (WHO, 2012) 7

  8. The 6th worst country(88) in terms of nutritional outcomes worldwid （Ethiopia）(The Global Hunger Index 2008) U-5 children underweight:34.4%(Oromiya) In 2013, 44% of the children U-5 were stunted with a regional differences; Amhara (52%), Tigray (51%), Addis Ababa (22%)，Gambella (27%) (Gezae & Regassa, 2013) U5M in Ethiopia 8

  9. The cause of U5M in south Africa Malnutrition is a major underlying and preventable factor in child deaths under the age of five. 9

  10. CTC (community-based therapeutic care) was found to be relatively more cost effective for severe acute malnutrition children in Sidama.(Asayehegn et al,2012) The culturally appropriate nutrition Education package based on the nutrition triangle model effectively prevented growth faltering and malnutrition among young children.( Swapan etal.2007) Community-based Health Planning and Services(CHPS) compound in Ghana is very successfulto reduce health inequalities and promote equity of health outcomes.(Esena, 2013) Current evidence 10

  11. Conceptual framework Social determinants(politic,econmic,culuture) Inadequate Household Food security Inadequate Maternal &child Health Inadequate Health service Factors insufficient dietary intake child disease Baseline Identificed case severe acute malnurtrition（6-59months） CHNPS Community-based intervention Reduce the SAM Post-intervention evaluation 11

  12. What is SAM? Severe acute malnutrition is defined by a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional oedema. Source:WHO:http://www.who.int/nutrition/topics/malnutrition/en/ 12

  13. Severe Acute Malnutrition Screening tool weight-for-height: WHO and UNICEF recommend the use of a cut-off for weight-forheight of below -3 standard deviations (SD) of the WHO standards to identify infants and children as having SAM. Reason： 1.A highly elevated risk of death. 2.Faster recovery. 3.In a well-nourished population, there are virtually no children below -3 SD (<1%). 13

  14. Aims and Objectives Aims:To reduce theburden of severe acute malnutritionn among under fives in Oromiya Region of Ethiopia. 14

  15. Hypotheses Hypotheses1 Nutrition condition of Children(6-59months) with SAM will improve after the RUTF intervention. Hypotheses2 KAP of mothers will improve after health education.Aims and Objectives 15

  16. Methods-design • Design – Cross-sectional study(before and after intervention) Quantitative Survey to determine the number of SAM and the nutrition status of U-5; KAP of mothers by use of questionnaire. Qualitative Interview of policy makers and community leaders on their perception of malnutrition in the region.Aims and Objectives 16

  17. Convening the research team Recuritment study subject Methods-study preparation 17

  18. Tool preparation WHO nutrition screening tool Child nutrition status questionnaire KAP questionnaire for mother Interview guide for policy maker Methods-study preparation 18

  19. Methods-Intervention Framework Baseline survey Demographic of U-5 child and mother; KAP of mother Nutrition situation; Qualitative interview for policy maker;Health status; et al SAM children (6-59months) RUTF Intervention Health education; Maternal health; Mothers Community &Policy maker CHNPS Post-intervention evaluation Demographic of child(SAM child) of mother;KAP of mother Nutrition situation of child;Health status; et al 19

  20. Community-based nutrition intervention The community-based approach involves timely detection of severe acute malnutrition in the community and provision of treatment for those without medical complications with ready-to-use therapeutic foods or other nutrient-dense foods at home. Intervention RUTF 20

  21. Population of U5 in Ethiopia-1,1883 U-5 in Omoriya-4, 723 U-5 in Omoriya with SAM-600 ( est. from EHDS,2011) Mothers(WRA)- estimated from SS of U-5 Policy makers- inteviews Intervention-target population Policy Maker Mother SAM （6-59months） Community 21

  22. Intervention-target population 22

  23. Intervention-SAM U5 CHILDREN Intervention Provide RUTF • Eight weeks • 10-15kg per person Vaccination Exclusive Breastfeeding Management of SAM • Therapeutic zinc fordiarrhoea • WASH • Feeding in diarrhoea • Malaria preventionin children • Deworming in children • Obesity prevention 23

  24. Intervention-Mother Health education • Nutrition • Child growth • Nutrition in pregnancy • Food security • Diet balance • Breastfeeding As volunteer 24

  25. Intervention-community Intervention CHNPS Compound • Community Health Nurse • Community volunteer • Recurit volunteer • Public health worker • Mother • Training volunteer • Identified the case • DistributeRUTF • Monitor 25

  26. SPSS version 17 Descriptive statistic. Eg. Frequency, means, SD,etc T-test for comparison Logistic analysis DataAnalysis 26

  27. Budget 27

  28. Reference 1. Curt Carnemark ,et al.2012.“Every year 3 million lives are loss due to undernutrition.” Ending poverty in Our Generation, page 62 , UNICF , Save the Chidren’s Vision for a post-2015 framework Ending Poverty. 2. John Isaac,et al.2012. “Undernutrition remains a major cause of disability and Mortality.” Global MonitoringReport 2012,page 21,World Bank, Food Prices, Nutrition, and the Millennium Development Goals. 3. Medhin ，et al. 2010.”It is the top cause of global burden of disease underlying 53% of deaths in children under five years.” Huffpost Health Living , page 79-84,The Global Burden of Disease and 'Big Science'. 4. 2003.“An estimated 200 million people (children and adults), are malnurtrion, increased by almost 20 percent since the early 1990s.” FAO,FAOSTAT 1963-2003. 5. Benson , Shekar , et al. 2006 .”More than 1/3 African children U5 are stunted with physical andcognitive challenges. “ paper23，UNICEF，Child nutrition interactive dashboard. 6. 2012 . “LEB m/f;62/65;POD U5 68/1000;POD (15-60yrs) m/f ;250/1000,212/1000 Total expenditure on health; per capita (Intl $) 44;Total expenditure on health;as % of GDP 3.8.”; page 56-67 , WHO , Concessional Finance and Global Partnerships. 7. 2008. “U5 children underweight:34.4%(Oromiya) The 6th worst country(88) in terms of nutritional outcomes worldwide.（Ethiopia）” page 8- 10,The Global Hunger Index. 8. Gezae ,Regassa ,et al. 2013. “In 2013, 44% of the children U5 were stunted with a greater regional differences Amhara (52%), Tigray (51%), Addis Ababa (22%)，Gambella (27%).“ page 28-32 , Nutritional status of children under five years of age inShire Indaselassie, North Ethiopia:Examining the prevalence and risk factors. 9. Agarwal. 2012.“Malnutrition is a major underlying and preventable factor in child deaths under the age of five.” page 5-6 , Ending Preventable Child Deaths: A Little More Effort Could Get the Job Done 10. 2006. “Severe acute malnutrition is defined by a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional oedema. “ Severe Acute Malnutrition , page1-4 , WHO, nutrition experts take action on malnutrition. 28

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