Performance of Community- based Management of Acute Malnutrition programme and its impact on nutritional status of children under five years of age in Malawi. A case of Lilongwe Rural MSc Research Proposal Presented by :Alice Nyasulu Supervisor: Dr A.M Mwangi Date: 19 th April

Background Information Malnutrition is the major problem in developing countries. Contributes over 50% of the million deaths from preventable causes, globally- PEM is the main cause The recommendation was to refer SAM children to hospital to receive therapeutic diets along with medical care-reduced case fatality by 55%.(WHO 2010). 2

Background cont’ Recent advent of ready to use therapeutic foods (RUTF) allowed the management of SAM in the community Malawi being one of the poor countries it became among the first to adopt home based approach of treating malnourished children. 3

Problem Statement Since inception of Community–based management of under five children with acute malnutrition in Lilongwe in 2006 its impact has not been assessed. Justification Implementation of CMAM involves utilization of scares resources it is important to determine whether the resources spent are bringing about expected results. 4

Study Aim To contribute to the improvement of the nutritional status of under five children in Malawi. Study purpose To provide information useful in ensuring that the programme is meeting its objectives through re-alignment of activities in line with the findings. 5

Main Objective To assess performance of CMAM and its impact on the nutritional status of children under five years in Lilongwe rural. Specific Objective To determine the socio economic and demographic status of the study household To determine the trend of nutritional status of under five children in the programme area. To determine the level of coverage of CMAM program compared to programme target. To establish the quality of service delivery for the programme. To establish whether there is an association between the nutritional status and the socio economic status of the household under study. 6

Research Questions What are the social demographic characteristics of the population under study? What is the trend of the nutrional status of under five children in Lilongwe rural? What type of CMAM services are being offered in the study area? What is the coverage of CMAM in the study area? What is the influence of social economic status on the nutritional status of under five children in the study area? 7

Hypotheses The community-based management has significantly improved nutritional status of under-five children in Lilongwe rural. 8

LITERATURE REVIEW 2.0 LITERATURE REVIEW 2.1 History of CMAM Causes of Malnutrition 2.2 Traditional Treatment of Acute Malnutrition 2.3 Community-based Management of Acute Malnutrition Case detection at community level Community Mobilization 2.4 Knowledge Gap 9

Knowledge Gap. Although community based management has been identified as one of effective management of malnutrition, it has been hit by many problems ranging from insufficient RUTF and not being cost effective. 10

METHODOLOGY Study site Lilongwe rural in the central region of Malawi In four randomly selected Traditional Authorities Study population Households with children 6-59 months Mothers/caretakers will be the respondent Study design Cross-section with retrospective component. 11

Sample size determination Fisher et al (1991) n= Z 2 pq/d 2 Z= Level of significant = p= Prevalence of indicators= 0.061(6.1%) q= 1-p d 2 =Degree of Precision = n = x ( ) n=88.01 n= 88 Minimum sample size Sample size of

13 Sampling Procedure

Inclusion and exclusion criteria Measuring unit Children from 6-56 months old. Beneficiaries and non beneficiaries 14

Study tools and equipment The following will be used Questionnaire to collect data on –Socio – demographic –Socio-economic –Health workers level of skill –Quality and quantity of equipment/ supplies Anthropometric equipment - Salter Scales -Length/height board -MUAC tape Clinical observation Key informant-will be used to obtain qualitative data on child care practices 15

Data collection Recruitment of field assistants with nutritional knowledge or hospital working experience Training of the field assistants and pre-testing of the questionnaire Re-calibration of scales on daily basis to ensure data acurancy. Checking equipment availability and adequacy. Anthropometric measurement of under five children 16

Data management and Analysis Data entry using SPSS computer packages and micro-soft excel Data cleaning and checking of outliers Data analysis using SPSS computer packages and microsoft excel 17

Variables to be analysed Demographic characteristics – Sex and age range – Age and sex distribution – Education levels of caregivers – Main source of income Nutrition status of under-five children – Height – Weight – MUAC – Child in programme or not CMAM Services – Flow of supply – Equipment availability – Knowledge and skills for service providers Association between socio-economic status and nutrition status. 18

19 ACTIVITIESITEM DESCRIPTIONDAYSUNIT COSTQUANTITYTOTAL Training1)Enumerators1 1,00022,000 2)stationary1 1,5001 3)other training material1 1,00033,000 4)Reseacher1 2,0001 5)Food ,250 Community mobilization1)reseacher1 1,0001 2)field assistance ,000 3)Community leaders ,000 Survey1) Equipment7 1,000321,000 2)reseacher7 2,000114,000 3)field Assistants7 1,000321,000 4) fuel7 2,000114,000 5)Stationary7 2, ,500 Supervision1)Airtickect169,7001 2)Per diem320,500161,500 TOTAL 232,450 BUDGET

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