COVID-19 adaptations to outpatient nutrition programmes in East Africa
This is a summary of the following paper: Shragai T, Talley L, Summers A et al (2022) Outcomes after Acute Malnutrition Program Adaptations to COVID-19, Uganda, Ethiopia, and Somalia. Emerging Infectious Diseases, 28, 13. https://doi.org/10.3201/eid2813.212266
After the onset of the COVID-19 pandemic, guidance for Community-Based Management of Acute Malnutrition (CMAM) was released to support the continuity of services while mitigating the risk of COVID-19 transmission. In response, countries adopted a variety of programme adaptations, including family mid-upper arm circumference (MUAC),1 longer intervals between clinic visits and MUAC-only programming. However, while experiences and lessons learnt have been documented in Field Exchange issue 64 (Wrabel et al, 2021), there remains a lack of data on the impact of implementing these adaptations at scale and as a part of routine programming.
The study reviewed here used routine CMAM programme data from Ethiopia (81 facilities), Somalia (12 facilities) and Uganda (five facilities) to evaluate changes in enrolment and treatment outcomes at facility level that corresponded with the implementation of COVID-19 programme adaptations (Table 1). In addition, eight facilities in Somalia provided child-level data for weight and MUAC at admission and discharge, and average length of stay (ALOS). The analysis adjusted for expected increases in enrolment due to seasonal periods of increased food insecurity and for expected decreases due to national COVID-19 mitigation measures, such as travel restrictions.
Table 1: Programme adaptations in Ethiopia, Somalia and Uganda
Country |
Programme type |
Dates data available; date adaptations began |
Programme adaptations |
Uganda |
Targeted supplementary feeding programme |
Jan 2019–Dec 2020; Apr 2020 |
Family MUAC; suspension of community screening; reduced frequency of follow-up visits from weekly to every two weeks; modified admission and discharge criteria from a MUAC threshold of 12.5 cm to 12.9 cm |
Ethiopia |
Outpatient therapeutic feeding programme |
Jul 2019–Dec 2020; May 2020 |
Family MUAC; suspension of community screening; reduced frequency of follow-up visits from weekly to every two weeks |
Somalia |
Outpatient therapeutic feeding programme |
Facility-level data: Nov 2019–Dec 2020; Mar 2020
Child-level data: Jan 2017–Nov 2020; Mar 2020 |
Family MUAC; suspension of community screening; reduced frequency of follow-up visits from weekly to every two weeks |
The study found no statistically significant changes in total admissions, ALOS, total children screened for admission or recovery rates at facility level before and after adaptations. Although several facilities closed temporarily because of stock outages, these closures were short-term – upon reopening, admissions and the total number screened returned to pre-closure levels. MUAC and weight at discharge did not change meaningfully within the Somalia facilities that provided child-level data. However, the ALOS did significantly increase immediately after adaptations, but then decreased to pre-adaptation levels. The authors highlight four limitations to the study: its limited statistical power; challenges in isolating the effects of CMAM programme adaptations from other simultaneous COVID-19 mitigation efforts; the limited number of countries studied; and, finally, the fact that models do not capture the important qualitative experience of putting programme adaptations into practice.
Nevertheless, overall, the results provide initial evidence that adaptations to CMAM programmes did not significantly affect programme efficacy when adopted in the context of the COVID-19 pandemic. However, there is a need for further prospective studies with greater power to evaluate how the COVID-19 programme adaptations affected performance outcomes.
References
Wrabel M, King S & Stobaugh H (2021) Adaptations to community-based acute malnutrition treatment during the COVID-19 pandemic. Field Exchange 64. https://www.ennonline.net/fex/64/covid19cmamadaptations
1 Family MUAC: Caregivers are trained to monitor their children's MUAC at home and to refer them to a community health worker or health facility when they detect signs of wasting.
More like this
FEX: Adaptations to community-based acute malnutrition treatment during the COVID-19 pandemic
View this article as a pdf Lisez cet article en français ici By Maria Wrabel, Sarah King and Heather Stobaugh Maria Wrabel is CMAM Adaptations Project Officer with...
FEX: Adaptations to community-based acute malnutrition treatment during the COVID-19 pandemic
This is a summary of a Field Exchange field article that was included in issue 64. The original article was authored by Maria Wrabel, Sarah King and Heather Stobaugh Maria...
FEX: Zambia efforts in prevention, early detection and treatment of wasting during COVID-19
View this article as a pdf By Getinet Babu, Agnes Aongola, Colleen Emary, Phyllis Oyugi, Claire Beck, Chansa Tembo Getinet Babu is a humanitarian nutritionist with over 16...
FEX: Zambia efforts in prevention, early detection and treatment of wasting during COVID-19
This is a summary of a Field Exchange field article that was included in issue 64. The original article was authored by Getinet Babu, Agnes Aongola, Colleen Emary, Phyllis...
FEX: Adapting infant and young child feeding interventions in the context of COVID-19 in Somalia
View this article as a pdf By Sahra Moalim Ahmed, Bishar Osman Hussein and Emmanuel Barasa Sahra Moalim Ahmed is an Infant and Young Child Feeding Officerat Concern Worldwide...
FEX: Implementing the Family MUAC approach for infants under six months in the context of COVID-19 in Ethiopia
This is a summary of a Field Exchange field article that was included in issue 64. The original article was authored by Ritu Rana, Hatty Barthorp, Mary T Murphy and Alemayhu...
FEX: Adaptations to CMAM programming in Cox’s Bazar in the context of the COVID-19 pandemic
View this article as a pdf Lisez cet article en français ici By Tracy Dube, Mary Chelang'at Koech, Piyali Mustaphi, Sandra Harlass, Jessica Bourdaire and Karanveer...
FEX: Use of RapidPro for remote collection of nutrition data during the drought emergency and COVID-19 pandemic in Zimbabwe
This is a summary of a Field Exchange field article that was included in issue 64. The original article was authored by Nakai Munikwa, Pauline Tsikayi, Desire Rwodzi, Mara...
FEX: Use of RapidPro for remote collection of nutrition data during the drought emergency and COVID-19 pandemic in Zimbabwe
View this article as a pdf By Nakai Munikwa, Pauline Tsikayi, Desire Rwodzi, Mara Nyawo and Mathieu Joyeux Nakai Munikwa is the Nutrition Cluster's Information Management...
FEX: The early detection of child wasting in Indonesia amidst the COVID-19 pandemic
View this article as a pdf This article outlines a family-centred screening programme for the early detection of child wasting which was piloted in March 2020 in selected...
FEX: Integrating screening for acute malnutrition into the vitamin A supplementation campaign in the Rohingya camps during the COVID-19 pandemic
View this article as a pdf Lisez cet article en français ici By Bakhodir Rahimov, Karanveer Singh and Piyali Mustaphi Bakhodir Rahimov is a Nutrition Sector...
FEX: FEX Digest
Read here summarised and simplified versions of select Field Exchange articles for a multi-sectoral audience. To sign up to the Field Exchange Digest alerts, please click...
FEX: Landscape analysis of simplified approaches to community-based management of acute malnutrition in the East and Southern Africa Region (ESAR)
View this article as a pdf This is a summary of the following report: https://www.simplifiedapproaches.org/_files/ugd/2bbe40_280957e3883a4b9a8bd2be47bb047998.pdf By Michele...
FEX: Infant and young child feeding in emergencies programming in the context of COVID-19: learnings from a webinar series
View this article as a pdf By Alessandro Iellamo, Linda Shaker Berbari, Ben Allen, Brooke Bauer, Aashima Garg, Andi Kendle, Peggy Koniz-Booher, Mija Ververs and Deborah Joy...
FEX: Adaptations to SMART surveys in the context of COVID-19 in Cox’s Bazar, Bangladesh
View this article as a pdf By Md. Lalan Miah, Bijoy Sarker, Jogie Abucejo Agbogan, Brigitte Tonon, Mary Chelang'at Koech and Md. Shahin Emtazur Rahman Md. Lalan Miah is...
FEX: FEX 65 editorial themes
View this article as a pdf Dear readers, A warm welcome to the 65th edition of Field Exchange. This edition features a range of programming issues that unfortunately reflect...
FEX: Bangladesh: The rationalisation of nutrition services in Rohingya camps
View this article as a pdf Bakhodir Rahimov is a Nutrition Sector Coordinator in Cox's Bazar, Bangladesh working with UNICEF Abid Hasan is an Information Management Officer...
FEX: Bangladesh: The rationalisation of nutrition services in Rohingya camps
View this article as a pdf This article outlines the provision of nutrition services in Cox's Bazar, an area where multiple partners work together to deliver to those in need...
en-net: WEBINAR - SAFELY RESUMING DOOR-TO-DOOR SURVEYS: DATA COLLECTION AND UTILIZATION IN THE CONTEXT OF COVID-19
Tech RRT in collaboration with SMART, GNC, GNC-Technical Alliance (formerly GTAM), IPC, UNICEF and Save the Children invites you to a new webinar to support nutritional surveys...
en-net: IYCF programming adaptations in the context of COVID 19 experiences from the field
Learning and Sharing Café IYCF programming adaptations in the context of COVID-19 The IFE Core Group, GTAM, UNICEF, WFP, Save the Children, Tech RRT and USAID...
Reference this page
COVID-19 adaptations to outpatient nutrition programmes in East Africa. Field Exchange 69, May 2023. p33. www.ennonline.net/fex/69/covid19-adaptations-to-outpatient-nutrition-programmes-in-east-africa
(ENN_7611)