Assessing the Impact of Integrated Community-Based Management of Severe Wasting Programs in Conflict-Stricken South Sudan: A Multi-Dimensional Approach to Scalability of Nutrition Emergency Response Programs

Andre M. N. Renzaho, Gilbert Dachi, Kibrom Tesfaselassie, Kiross Tefera Abebe, Ismail Kassim, Qutab Alam, Nawal Sadick Shaban, Tesfatsion Shiweredo, Hari Vinathan, Chandrakala Jaiswal, Hellen Martin Abraham, Khamisa Ayoub Miluwa, Rashidul Alam Mahumud, Eric Ategbo, Biram Ndiaye and Mohamed Ag Ayoya
Additional contact information
Andre M. N. Renzaho: Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
Gilbert Dachi: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Kibrom Tesfaselassie: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Kiross Tefera Abebe: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Ismail Kassim: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Qutab Alam: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Nawal Sadick Shaban: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Tesfatsion Shiweredo: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Hari Vinathan: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Chandrakala Jaiswal: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Hellen Martin Abraham: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Khamisa Ayoub Miluwa: Nutrition Department, South Sudan Ministry of Health, Juba 81111, Sudan
Rashidul Alam Mahumud: NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
Eric Ategbo: UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
Biram Ndiaye: UNICEF Somalia, RA International Compound, Aden Adde International Airport Area, Mogadishu, Somalia
Mohamed Ag Ayoya: UNICEF Somalia, RA International Compound, Aden Adde International Airport Area, Mogadishu, Somalia

IJERPH, 2021, vol. 18, issue 17, 1-24

Abstract: Community-based management of severe wasting (CMSW) programs have solely focused on exit outcome indicators, often omitting data on nutrition emergency preparedness and scalability. This study aimed to document good practices and generate evidence on the effectiveness and scalability of CMSW programs to guide future nutrition interventions in South Sudan. A total of 69 CMSW program implementation documents and policies were authenticated and retained for analysis, complemented with the analyses of aggregated secondary data obtained over five (2016–2020 for CMSW program performance) to six (wasting prevention) years (2014–2019). Findings suggest a strong and harmonised coordination of CMSW program implementation, facilitated timely and with quality care through an integrated and harmonised multi-agency and multidisciplinary approach. There were challenges to the institutionalisation and ownership of CMSW programs: a weak health system, fragile health budget that relied on external assistance, and limited opportunities for competency-based learning and knowledge transfer. Between 2014 and 2019, the prevalence of wasting fluctuated according to the agricultural cycle and remained above the emergency threshold of 15% during the July to August lean season. However, during the same period, under-five and crude mortality rates (10,000/day) declined respectively from 1.17 (95% confidence interval (CI): 0.91, 1.43) and 1.00 (95% CI: 0.75, 1.25) to 0.57 (95% CI: 0.38, 0.76) and 0.55 (95% CI: 0.39, 0.70). Both indicators remained below the emergency thresholds, hence suggesting that the emergency response was under control. Over a five-year period (2016–2020), a total of 1,105,546 children (52% girls, 48% boys) were admitted to CMSW programs. The five-year pooled performance indicators (mean [standard deviations]) was 86.4 (18.9%) for recovery, 2.1 (7.8%) for deaths, 5.2 (10.3%) for defaulting, 1.7 (5.7%) for non-recovery, 4.6 (13.5%) for medical transfers, 2.2 (4.7%) for relapse, 3.3 (15.0) g/kg/day for weight gain velocity, and 6.7 (3.7) weeks for the length of stay in the program. In conclusion, all key performance indicators, except the weight gain velocity, met or exceeded the Humanitarian Charter and Minimum Standards in Humanitarian Response. Our findings demonstrate the possibility of implementing robust and resilient CMSAM programs in protracted conflict environments, informed by global guidelines and protocols. They also depict challenges to institutionalisation and ownership.

Keywords: South Sudan; community-based management of severe wasting; effectiveness of treatment; relapse (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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