Perceptions of usage and unintended consequences of provision of ready-to-use therapeutic food for management of severe acute child malnutrition. A qualitative study in Southern Ethiopia.
BACKGROUND
Severe acute child malnutrition (SAM) is associated with high risk of mortality. To increase programme effectiveness in management of SAM, community-based management of acute malnutrition (CMAM) programme that treats SAM using ready-to-use-therapeutic foods (RUTF) has been scaled-up and integrated into existing government health systems. The study aimed to examine caregivers' and health workers perceptions of usages of RUTF in a chronically food insecure area in South Ethiopia.


METHODS
This qualitative study recorded, transcribed and translated focus group discussions and individual interviews with caregivers of SAM children and community health workers (CHWs). Data were complemented with field notes before qualitative content analysis was applied.


RESULTS
RUTF was perceived and used as an effective treatment of SAM; however, caregivers also see it as food to be shared and when necessary a commodity to be sold for collective benefits for the household. Caregivers expected prolonged provision of RUTF to contribute to household resources, while the programme guidelines prescribed RUTF as a short-term treatment to an acute condition in a child. To get prolonged access to RUTF caregivers altered the identities of SAM children and sought multiple admissions to CMAM programme at different health posts that lead to various control measures by the CHWs.


CONCLUSIONS
Even though health workers provide RUTF as a treatment for SAM children, their caregivers use it also for meeting broader food and economic needs of the household endangering the effectiveness of CMAM programme. In chronically food insecure contexts, interventions that also address economic and food needs of entire household are essential to ensure successful treatment of SAM children. This may need a shift to view SAM as a symptom of broader problems affecting a family rather than a disease in an individual child.
Department Women's and Children's Health, International Maternal and Child Health Uppsala University, SE-75185 Uppsala, Sweden, Department of Reproductive Health, Population and Nutrition, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia and.
Elazar
E
Tadesse
Department of Reproductive Health, Population and Nutrition, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia and.
Yemane
Y
Berhane
Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity Studies, Stockholm, Sweden.
Anders
A
Hjern
Department Women's and Children's Health, International Maternal and Child Health Uppsala University, SE-75185 Uppsala, Sweden.
Pia
P
Olsson
Department Women's and Children's Health, International Maternal and Child Health Uppsala University, SE-75185 Uppsala, Sweden, Lotta.Ekstrom@kbh.uu.se.
Eva-Charlotte
EC
Ekström
D000208:Acute Disease; D015362:Child Nutrition Disorders / Q000178:diet therapy*; D002675:Child, Preschool; D003153:Community Health Services / Q000191:economics; D019468:Disease Management; D005002:Ethiopia; D005191:Family Characteristics; D017144:Focus Groups; D005523:Food Supply / Q000191:economics*; D006078:Government Programs; D006801:Humans; D036301:Qualitative Research
Community-based management; Ethiopia; RUTF; SAM; chronic food insecurity; perceptions