Performance of the community based management of acute malnutrition (cmam) programme for children 6-59 months old in lilongwe rural, Malawi
Since the inception of the community based management of acute malnutrition in 2006 in Lilongwe rural the process has not been assesed to gauge its perfomance. The main objective of this study was to assess the performance of the programme in meeting the programme internationally set standards. This was achieved by determining the programme coverage, recovery and death rates. Secondary objectives included determination of strengths and weaknesses of the programme and the association between nutritional status of the children and their social economic or demographic characteristics. A combination of cross sectional and retrospective designs was used with both descriptive and analytical approaches. A total of 195 households with children aged 6-59 months were selected. Information on household socio-economic and demographic characteristics and children’s anthropomentry measurement was collected using pre-tested questionnaires with the help of trained interviewers. A 24-hour recall period was used for individual dietary diversity score of the child. The assessment of the nutrition status of children 6-59 months was used to determine the coverage. Data from the month of August 2011-July 2012 was collected from health facilities implementing the programme in the study area to determine recovery and death rates and the adherence to CMAM protocol. Focus group discussions and key informant interviews were conducted to determine the strengths and the weaknesses of the programme. Descriptive summary statistics including frequencies, means, medians and standard deviations were used to describe the characteristics of study population. Inferential statistics; Fisher’s Exact, Confidence Interval, P- value, Spearman’s correlations and Logistic regression were used to determine association between various dependent and independent variables. Quantitative analysis was used to analyse performance indicators such as coverage, casefatality, default and recovery rates. In total, 1012 (50.01% males and 49.9% females) were included in the study. The mean household size of 5.1 (±1.8) was found. The age dependency ratio was 120. Stunting was detected in 47.5% of the children, placing the area at high levels of chronic malnutrition. The findings indicated higher level of wasting (7.1%) than reported in Malawi demographic health survey of 2010 which was 4%. xvi The level of coverage was just on the borderline (50%) resulting in the programme leaving out a substantial proportion of malnuourished children in the community unidentified. The recovery and death rates were both within the minimum standard of >75%, and <10 respectively as stipulated in the International Standard Sphere. There was a significant association between the educational level of the mother and the nutritional status of the child in both stunting and underweight of the children (p <0.05), The individual dietary diversity score of the child had significant association (p < 0.05) with the nutritional status. The household monthly income had positive and significant correlation with stunting ( r = 0.130*, p < 0.05). Logistic regression analysis showed that the breast feeding status and mothers educational level were significantly associated (p=0.001, p=0.044) respectively, with the likelihood ratio or the ODDS ratio of 13.43. Despite the inconsistent supply of stationery, anthropometric equipment and RUTF, and lack of supervision which were raised as serious issues contributing to the negative performance of the programme, most mothers with their children in the programme reported that their children benefited from the programme through the RUTF ration and the nutrition counselling received from the programme. The study concludes that malnutrition still remains a big problem among children 6-59 months old. Educational level of the mothers and breast feeding status are a determinant of malnutrition amoung children 6-59 months old. This study suggest that promoting education among women in the study area could be a means of increasing income through employment and also as a means of acquiring knowledge on how to use the resources at their disposal.