TITLE:
Community Based Management of Severe Acute Malnutrition: The MSF Experience from an Urban Slum Setting in Bangladesh
AUTHORS:
Engy Ali, Pascale Delchevalerie, Zubair Shams, Petra Alders, Rony Zachariah
KEYWORDS:
Severe Acute Malnutrition, Community Based Management, Nutrition Outcomes, Urban Slum, Bangladesh
JOURNAL NAME:
Food and Nutrition Sciences,
Vol.11 No.6,
June
28,
2020
ABSTRACT: Background: Until recently, the experience on implementing community based
management of acute malnutrition (CMAM) among children has been largely based
in African settings. While the government in Bangladesh is yet to scale up CMAM
approach, there is still paucity of knowledge on the experience of CMAM within
the complex milieu of an urban slum context. In Kamrangirchar slum, Dhaka,
Bangladesh, this paper describes a CMAM programme performance and outcomes run
by Médecins Sans Frontières (MSF)/Doctors without Borders, in light to
performance indicators set by MSF and the Sphere minimum standards. Methods: This was a descriptive retrospective study using routinely collected programme
data of children admitted with severe acute malnutrition between May 2010 and
November 2011. Kamrangirchar is an urban slum of a large migrant population in
Dhaka, Bangladesh. Results: There was a total of 640 new admissions, of
whom 333 (52%) were males. The median age was 18 months (Inter-quartile range
(IQR) 12 - 41). 599 children had a reported nutritional outcome at discharge
from ambulatory therapeutic feeding centre (ATFC), this included: cure rate of
69% with an average length of stay of 68.8 (SD ± 46.0) days and average weight
gain of 3.8 g/kg/day (SD ± 2.7). The lost-to-follow-up rate was 18% and 5%
reported to the programme that they will leave the slum and go back to their
villages. These performance indicators did not meet the threshold level
indicators set by MSF and Sphere standards. Conclusions: Our experience
highlights the need for developing more adapted and contextualised indicators
for assessing the performance of CMAM programmes in settings such as urban
slums. Community engagement in the process of developing relevant standards is
crucial. Nutrition humanitarian actors have a vital role to collaborate with
local authorities to contextualize and refine these standards.