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Observational Study
. 2022 Sep 8;22(1):532.
doi: 10.1186/s12887-022-03585-8.

Influence of a quality improvement intervention on rehabilitation outcomes of children (6-24 months) with acute malnutrition: a retrospective study in rural Angola

Andrea Pietravalle  1 , Alessandro Baraldi  2 , Martina Scilipoti  2 , Francesco Cavallin  3 , Magda Lonardi  2 , Ivo Makonga Tshikamb  4 , Claudia Robbiati  2 , Daniele Trevisanuto  5 , Giovanni Putoto  6
Affiliations
Observational Study

Influence of a quality improvement intervention on rehabilitation outcomes of children (6-24 months) with acute malnutrition: a retrospective study in rural Angola

Andrea Pietravalle et al. BMC Pediatr. .

Abstract

Background: Defaulting is the most frequent cause of Community Management of Acute Malnutrition (CMAM) program failure. Lack of community sensitization, financial/opportunity costs and low quality of care have been recognized as the main driving factors for default in malnutrition programs. The present study aimed to evaluate if a logistic reorganization (generic outpatient department, OPD vs dedicated clinic, NRU) and a change in management (dedicated vs non dedicated staff) of the follow-up of children between 6 and 24 months of age with acute malnutrition, can reduce the default, relapse and readmission rate and increase the recovery rate.

Methods: Retrospective observational study on the impact of quality improvement interventions on rehabilitation outcomes of children (6-24 months) with acute malnutrition, admitted at the Catholic Mission Hospital of Chiulo (Angola) from January 2018 to February 2020. Main outcome measures were recovery rate, the default rate, the relapse rate, and the readmission rate.

Results: The intervention was associated with a decrease in the default rate from 89 to 76% (p = 0.02). Recovery rate was 69% in OPD and 88% in NRU (p = 0.25). Relapse rate was nil.

Conclusions: The present study supports the hypothesis that an improvement in quality of care can positively influence the rehabilitation outcomes of malnourished children. Further studies are needed to identify children at risk of low adherence to follow-up visits to increase the effectiveness of rehabilitation programs.

Keywords: Acute malnutrition; Default; Nutritional rehabilitation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Scheme of intervention
Fig. 2
Fig. 2
Flow-chart of patients during follow-up (OPD January-July 2018 vs. NRU June-November 2019)
Fig. 3
Fig. 3
Flow-chart of patients during follow-up (OPD April-July 2018 vs. NRU August-November 2019)
Fig. 4
Fig. 4
Association between default rate and distance from Chiulo
Fig. 5
Fig. 5
Flow-chart of patients living in Chiulo area during follow-up (OPD January-June 2018 vs. NRU June-November 2019)
See this image and copyright information in PMC

References

    1. Ashworth A. Nutrition, Food Security, and Health, Chapter 46. In Nelson Textbook of Pediatrics, 20TH ed.; Kliegman, Robert M.; Stanton, Bonita M.D.; St. Geme, Joseph; Schor, Nina F.; Elsevier Health Sciences, 2015.
    1. UNICEF/WHO/The World Bank Group Joint child malnutrition estimates. Levels and trends in child malnutrition, 2018 edition.
    1. FAO; IFAD; UNICEF; WFP; WHO. The State of Food Security and Nutrition in the World 2018. Building climate resilience for food security and nutrition, 2018.
    1. Instituto Nacional de Estatística; Ministério do Planeamento. Recenseamento Geral da População e Habitação, 2014 Angola.
    1. World Vision international . Review of current Community Management of Acute malnutrition (CMAM) practice and outcomes in 12 countries using the minimum reporting package. 2012.

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