M H Kamara1, R Najjemba2, J van Griensven3, D Yorpoi1, A S Jimissa1, A K Chan4,5, S Mishra5. 1. Sierra Leone Ministry of Health and Sanitation, Magburaka, Sierra Leone. 2. School of Public Health, Makerere College of Health Sciences, Kampala, Uganda. 3. Institute of Tropical Medicine, Antwerp, Belgium. 4. Dignitas International, Zomba, Malawi. 5. Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
Setting: All health facility and community malnutrition screening programmes in Tonkolili, a rural Ebola-affected district in Sierra Leone. Objectives: Before the Ebola disease outbreak, Sierra Leone had set a goal to reduce the prevalence of severe acute malnutrition (SAM) in children aged <5 years to <0.2%. We compared the number of children screened, diagnosed and treated for malnutrition before, during and after the outbreak (2013-2016). Design: This was a retrospective cross-sectional study. Results: Health facility screening declined from 16 805 children per month pre-outbreak to 13 510 during the outbreak (P = 0.02), and returned to pre-outbreak levels after the outbreak. Community-based screening remained stable during the outbreak, and increased by 30% post-outbreak (P < 0.001). The proportion diagnosed with moderate acute malnutrition using mid-upper arm circumference increased from respectively 3.6% and 5.1% pre-outbreak in the community and health facilities to 8.2% and 7.9% post-outbreak (P < 0.001, P = 0.003). The proportion of children diagnosed with SAM using a weight-for-age ratio at health facilities increased from 1.5% pre-outbreak to 3.5% post-outbreak (P = 0.003). On average, for every four children diagnosed with SAM per month, one child completed SAM treatment. Conclusion: After a decline in screening during the Ebola outbreak, diagnoses of acute malnutrition increased post-outbreak. Nutrition programmes need to be strengthened to pre-empt such effects in the event of future Ebola outbreaks.
Setting: All health facility and community malnutrition screening programmes in Tonkolili, a rural Ebola-affected district in Sierra Leone. Objectives: Before the Ebola disease outbreak, Sierra Leone had set a goal to reduce the prevalence of severe acute malnutrition (SAM) in children aged <5 years to <0.2%. We compared the number of children screened, diagnosed and treated for malnutrition before, during and after the outbreak (2013-2016). Design: This was a retrospective cross-sectional study. Results: Health facility screening declined from 16 805 children per month pre-outbreak to 13 510 during the outbreak (P = 0.02), and returned to pre-outbreak levels after the outbreak. Community-based screening remained stable during the outbreak, and increased by 30% post-outbreak (P < 0.001). The proportion diagnosed with moderate acute malnutrition using mid-upper arm circumference increased from respectively 3.6% and 5.1% pre-outbreak in the community and health facilities to 8.2% and 7.9% post-outbreak (P < 0.001, P = 0.003). The proportion of children diagnosed with SAM using a weight-for-age ratio at health facilities increased from 1.5% pre-outbreak to 3.5% post-outbreak (P = 0.003). On average, for every four children diagnosed with SAM per month, one child completed SAM treatment. Conclusion: After a decline in screening during the Ebola outbreak, diagnoses of acute malnutrition increased post-outbreak. Nutrition programmes need to be strengthened to pre-empt such effects in the event of future Ebola outbreaks.
Entities:
Keywords:
SORT IT; child; health systems strengthening; operational research; therapeutic feeding
Authors: M Edginton; D Enarson; R Zachariah; T Reid; S Satyanarayana; K Bissell; S G Hinderaker; T Harries Journal: Public Health Action Date: 2012-03-21
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: Lancet Date: 2007-10-20 Impact factor: 79.321
Authors: J W T Elston; A J Moosa; F Moses; G Walker; N Dotta; R J Waldman; J Wright Journal: J Public Health (Oxf) Date: 2016-12-02 Impact factor: 2.341
Authors: Jody R Lori; Sarah Danielson Rominski; Joseph E Perosky; Michelle L Munro; Garfee Williams; Sue Anne Bell; Aloysius B Nyanplu; Patricia N M Amarah; Carol J Boyd Journal: BMC Pregnancy Childbirth Date: 2015-10-12 Impact factor: 3.007
Authors: Odell W Kumeh; Mosoka P Fallah; Ishaan K Desai; Hannah N Gilbert; Jason B Silverstein; Sara Beste; Jason Beste; Joia S Mukherjee; Eugene T Richardson Journal: BMJ Nutr Prev Health Date: 2020-12-01