Menu ENN Search

Factors associated with defaulting in MSF ambulatory programme

Summary of meeting abstract1

Children participate in the obligatory 'appetite' taste for RUTF

Since Médecins Sans Frontières (MSF) changed its treatment approach from centre-based to 'ambulatory' therapeutic feeding programmes (ATFP), a considerable number of programmes have experienced high defaulter rates. In 2006, 15 (68%) of the 22 MSF Holland ambulatory programmes had a defaulter rate of > 15%, three ATFPs (14%) had a defaulter rate of 10- 15%, and only four (18%) had a defaulter rate of < 10%. As a result, MSF conducted a study to identify key factors underlying defaulting.

Quantitative and qualitative data on defaulting was collected in programmes in south Sudan, Darfur, Myanmar, Ivory Coast and Ethiopia. Defaulting children were defined as missing a follow-up appointment more than twice. Semi-structured and indepth interviews were conducted with caretakers of enrolled children in south Sudan and Darfur about personal or community attitudes to ambulatory therapeutic care programmes and barriers to participation. Defaulters were not interviewed due to time, transport and security constraints. Further information was gathered through observations of programmes and from programme reports. Statistical analysis was performed on data from registration books and patient files to examine characteristics of defaulters. This involved analysis of timing of defaulting, gender and distance to programme.

The results demonstrated no significant difference in age, gender or weight for height on admission between cured children and defaulting children. In south Sudan, Darfur and Myanmar, 55%, 44% and 62% of patients defaulted immediately after admission or the first follow-up visit.

Comparison between programmes in South Sudan showed that average length of stay before defaulting was related to the type of care the child received. In-patients averaged 48 days before defaulting, children who spent the first week in day-care averaged 12 days, and out-patients averaged 6 days. Programme default rates were related to intensity of outreach work; programmes with well-established outreach (Ivory Coast, Darfur and Myanmar) had default rates of <10% while those without outreach (south Sudan and Ethiopia) had default rates >30%.

Distance to ambulatory therapeutic care programmes was not related to defaulting, except for people living very far away (e.g. two days walk away). In Darfur, patients who travelled 8 hours by donkey were twice as likely to default compared to people living relatively nearby (p=0.001). Caretakers' appreciation of the programme was high but their understanding of malnutrition, target weight and treatment duration was poor. Community attitudes to ATFP were not a barrier to participation.

Conclusions

Around half the defaulters left the programme soon after joining. This appears to be associated with poor communication with caretakers, unreliability of centre opening hours and food availability. There is a need for a more patient-centred approach to ensure caretakers are informed of the aim of the treatment, exit criteria, expected duration and number of visits, and are motivated to continue follow-up visits. Outreach workers have a vital role to play in this. Programme planners should ensure reliability of programme services, such as standard opening hours, continuous availability of food and the use of standard ATFP patient files to reduce defaulting.

Show footnotes

1Van der Velden. E and van der Kam. S (2008). Key factors underlying defaulting in MSF ambulatory therapeutic feeding programmes. MSF Scientific Day Report. 'Research shaping the way we work'. 5th June 2008. http://www.msf.org.uk/scientificday.event

More like this

FEX: Ambulatory treatment of severe malnutrition in Afghanistan

By Emmanuelle Lurqin Emmanuelle is a paediatric nurse and since 2000, has worked with MSF Belgium on nutrition programmes in Angola, Burundi, and Afghanistan. She is currently...

FEX: High OTP coverage through the Ministry of Health in Chad

By Casie Tesfai Casie Tesfai is currently the Nutrition Technical Advisor for the International Rescue Committee based in New York. She has 10 years of nutrition experience...

FEX: Delivering Supplementary and Therapeutic Feeding in Darfur: coping with Insecurity

By Gwyneth Hogley Cotes, GOAL Gwyneth joined GOAL in November, 2005 as the Nutrition Coordinator for Darfur, Sudan. She has a BA in International Studies and Master of Public...

FEX: Ambulatory treatment of severe malnutrition

Severely malnourished child with father Commentary by Dr. Steve Collins Dr. Steve Collins is a medical doctor with a doctorate in nutrition during emergency operations. He is...

FEX: Home treatment for severe malnutrition in South Sudan

By Josephine Querubin, ACF-USA Josephine Querubin is a medical doctor who has been working in humanitarian work for the past 12 years. Beginning in her home country, the...

FEX: Coverage Monitoring Network Profile

Since the start of operations in August 2012, the Coverage Monitoring Network (CMN) has supported a total of 50 coverage assessments, with nine implementing organisations...

FEX: Simplifying the response to childhood malnutrition: MSF’s experience with MUAC-based (and oedema) programming

By Kevin P.Q. Phelan, Candelaria Lanusse, Saskia van der Kam, Pascale Delchevalerie, Nathalie Avril and Kerstin Hanson Kevin P.Q. Phelan was the Nutrition Working Group Leader...

Defaulter and Access Study

Donor: OFDA Collaborators: CDC, ACF, Concern Worldwide, Save the Children UK ENN Project Lead: Jeremy Shoham Timeframe: Project completed in 2011 (report forthcoming)...

FEX: Letter on community mobilisation in outpatient management of severe malnutrition, by Saul Guerrero and Steve Collins

Community mobilisation at the core of outpatient treatment of severe malnutrition Dear Editor, There is now a robust evidence base demonstrating that the outpatient care...

FEX: Constraints to achieving Sphere minimum standards for SFPs in West Darfur: a comparative analysis

A view of Mornei camp The current conflict in Sudan's westernmost state of Darfur began in early 2003, although most humanitarian agencies only gained access to the area and...

FEX: CTC in South Sudan - A Comparison of Agency Approaches and the Dilemmas Involved (Special Supplement 2)

Tanya Khara (Valid International), Jennifer Martin (Concern Worldwide), Ed Walker (Tearfund) Introduction In 2003 both Concern Worldwide and Tearfund asked Valid...

FEX: Highlights from MSF-hosted meeting on outpatient and community based therapeutic care

By Kirsti Lattu, MSF Programme Officer and Caroline Grobler-Tanner, Independent Nutrition Advisor Examining an infant in the TFC. Maradi, Niger In 2005, Médecins Sans...

FEX: Malnutrition peaks during malaria epidemic in Northwest Nigeria

By Chloë Wurr, Joke Zeydner and Saskia van der Kam Chloë Wurr is a medical doctor in Alaska and worked as medical coordinator with MSF-OCA Nigeria Joke...

FEX: CTC from Scratch - Tear Fund in South Sudan (Special Supplement 2)

By Ed Walker (Tearfund) Beneficiaries collecting their general ration in South Sudan. Tearfund has been working in Northern Bahr el Ghazal, southern Sudan, in the nutrition...

FEX: Case Studies (Special Supplement 2)

3.1 CTC in Ethiopia- Working from CTC Principles Isolated village in the highlands of South Wollo, Ethiopia. By Kate Golden (Concern Ethiopia) and Tanya Khara (Valid...

FEX: Emerging cases of malnutrition amongst IDPs in Tal Abyad district, Syria

By Maartje Hoetjes, Wendy Rhymer, Lea Matasci-Phelippeau, Saskia van der Kam Maartje Hoetjes is a Medical member of the MSF emergency team, currently working in South Sudan....

en-net: The implication of the New 12.5cm MUAC OTP discharge criteria

As per my information from colleague, NUGAG has recommended the 12.5cm discharge criteria as opposed to weight gain. The panel of expert agreed that % weight gain was incorrect...

NEX: Tackling high defaulting rates in refugee camp settings – lessons from Chad

Seife Kifleyohannes Temere Seife Kifleyohannes Temere is a Nurse Nutritionist. He has been working for International Medical Corps since 2010. In eastern Chad there are 12...

en-net: We are Working Against "Default Definition, Aren't we?

With some health workers we may notice high number of defaulters in the CMAM program. Without consultation and follow up, this issue continues for months and years and may...

en-net: Defaulter in moderate acute malnutrition

I am working in Bangladesh. Here I have observed that defaulter rate is high (12-16%). Among the different reasons one of the most important reason is that family shifted from...

Close

Reference this page

E Van der Velden and S Van der Kam (2008). Factors associated with defaulting in MSF ambulatory programme. Field Exchange 34, October 2008. p8. www.ennonline.net/fex/34/factors

(ENN_3826)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.