Defaulter Access Study
The Defaulter and Access Study aims to improve the design of programmes addressed to reducing moderate and severe acute malnutrition, by adapting them to the constraints faced by potential beneficiaries in a variety of emergency settings.
The objectives of the study are:
• To describe the baseline and nutritional characteristics of beneficiaries likely to default from nutrition programmes.
• To understand the determinants of defaulting from nutrition programmes in a variety of emergency settings.
• To compare the determinants of defaulting between different emergency settings.
• To translate observations into strategy and policy recommendations to adapt nutrition programming in emergencies.
• To develop field tools to understand defaulting in particular settings and respond with appropriate programme adaptations.
The subjects of this study are children between 6 to 59 months admitted to SFPs. This study intends to capture:
• Frequency and baseline characteristics of patients who default (socio-demographic, nutrition status, evolution under treatment).
• Unexpected events that trigger defaulting through change in family priorities (i.e. determinants that can only be collected post-hoc – once the event has happened).
• Reasons for non-attendance of malnourished children to SFP (i.e. malnourished children who never enrol in an SFP).
The causes of defaulting from SFPs are considered to be context-specific and due to seasonal factors. Therefore several independent studies will be implemented, to allow description of the causes of defaulting in specific contexts.
Four sites will be selected, each study taking place over a complete agricultural season. Settings to be included are a refugee camp, a long term intervention (protracted emergency) in a secure setting, a recent crisis in a volatile setting with insecurity, and a centre where displaced and resident populations attend. Selection of sites will aim to include programmes from Africa and Asia, as well as a mixture of programmes with high and low defaulting rates.
Stages of implementation
The study will involve a number of stages. The preliminary phase will include
developing hypotheses of the main causes of defaulting and non-attendance in different contexts and questionnaires based on these hypotheses for data collection in the quantitative phase of the study. This will be followed by qualitative data collection in two pilot settings and development of questionnaires to identify potential causes of defaulting and non-attendance and inform questionnaire design. Two questionnaires will be developed based on this information:
i) The Baseline Questionnaire, for obtaining baseline information on the family.
ii) The Unexpected Events Questionnaire, a (shorter) questionnaire to identify unexpected events that may be related to defaulting.
The next stage will be the prospective data collection phase in each study site and subsequent analysis. The study will involve case control of those children who do not default, as well as follow up of those who do not attend the programme.
The analysis will first be undertaken for each independent study site. This will involve analysis of different categories of defaulting groups as follows: early defaulting (first two weeks), defaulting after weight gain, and defaulting after weight loss or no-weight gain. Secondary analysis will involve non-statistical comparisons of the results obtained in each study site, with the aim of identifying context specific results and those which are common to all programmes.
Additional analysis will be conducted in countries where a change in programme characteristics (protocols, strategy or external events) may have affected the likelihood of defaulting or its causes. This will be carried out as a ‘before-after’ comparison of time series data, with defaulting as the event of interest. This will be treated as opportunistic research.
For further details, contact Jeremy Shoham, email: jshoham@easynet.co.uk
