Embracing community -based management of severe malnutrtion; a way forward for Tanzania

Severe acute malnutrition remains a major killer of children under five years of age in Tanzania, however, treatment is still restricted to facility-based approaches, which greatly limit its coverage and impact. New evidence suggests, however, that large numbers of children with severe acute malnutrition can be treated in their communities without being admitted to a health facility or a therapeutic feeding centre. The community-based approach involves timely detection of severe acute malnutrition in the community and provision of treatment for those without medical complications with ready-to-use therapeutic foods (RUTF) or other nutrient-dense foods at home. If properly combined with a facility-based approach for those malnourished children with medical complications and implemented on a large scale, community-based management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children in Tanzania.

In Tanzania, the majority of children who have severe acute malnutrition are never brought to health facilities. In these cases, only an approach with a strong community component can provide them with the appropriate care. Evidence shows that about 80 per cent of children with severe acute malnutrition who have been identified through active case finding, or through sensitizing and mobilizing communities to access decentralized services themselves, can be treated at home

Having worked well in emergency settings resulting in a dramatic increase of the program coverage and consequently, of the number of children who were treated successfully – yielding a low case-fatality rate ,community-based management of severe acute malnutrition is a way forward in countries like Tanzania with high prevalence of severe acute malnutrition. This will prevent hundreds of thousands of child deaths who otherwise do not make it to health facilities in Tanzania

In addition, scale up of community –based management of severe acute malnutrition in Tanzania should run hand in hand with an extensive prevention strategy. Preventive interventions can include: improving access to high-quality foods and to health care; improving nutrition and health knowledge and practices; effectively promoting exclusive breastfeeding for the first six months of a child’s life where appropriate; promoting improved complementary feeding practices for all children aged 6–24 months — with a focus on ensuring access to age-appropriate complementary foods (where possible using locally available foods); and improving water and sanitation systems and hygiene practices to protect children against communicable diseases

Recommendation to the government

The government should adopt and promote policies and programs that:

· Ensure that national protocols for the management of severe acute malnutrition (based, if necessary, on the provision of RUTF) have a strong community-based component that complements facility-based activities.

· Achieve high coverage of interventions aimed at identifying and treating children in all parts of the country and at all times of the year through effective community mobilization and active case finding.

· Provide training and support for community health workers to identify children with severe acute malnutrition who need urgent treatment and to recognize those children with associated complications who need urgent referral.

· Establish adequate referral arrangements for children suffering from complicated forms of severe acute malnutrition so they can receive adequate inpatient treatment.

· Provide training for improved management of severe acute malnutrition at all levels, involving an integrated approach that includes community- and facility-based component

http://www.who.int/nutrition/topics/Statement_community_based_man_sev_acute_mal_eng.pdf
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