Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

Stefania Moramarco, Giulia Amerio, Jean Kasengele Chipoma, Karin Nielsen-Saines, Leonardo Palombi and Ersilia Buonomo
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Stefania Moramarco: Department of Biomedicine and Prevention, University of Rome Tor Vergata, via Montpellier, Rome 00133, Italy
Giulia Amerio: Rainbow Project Association Pope John 23rd, 5656 Chinika Road, Ndola 10101, Zambia
Jean Kasengele Chipoma: Ndola District Health Office, 1307 Naidu Close, Ndola 10101, Zambia
Karin Nielsen-Saines: Department of Pediatrics, David Geffen UCLA School of Medicine School of Medicine, Los Angeles, CA 90095, USA
Leonardo Palombi: Department of Biomedicine and Prevention, University of Rome Tor Vergata, via Montpellier, Rome 00133, Italy
Ersilia Buonomo: Department of Biomedicine and Prevention, University of Rome Tor Vergata, via Montpellier, Rome 00133, Italy

IJERPH, 2018, vol. 15, issue 9, 1-17

Abstract: Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children ( p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled.

Keywords: child malnutrition; community-based management of acute malnutrition—CMAM; moderate acute malnutrition—MAM; severe acute malnutrition—SAM; supplementary feeding programs—SFP; underweight; Zambia (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
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