Community-based management of acute malnutrition (CMAM) in sub-Saharan Africa: Case studies from Ghana, Malawi, and Zambia
Community-based management of acute malnutrition (CMAM) in sub-Saharan Africa: Case studies from Ghana, Malawi, and Zambia
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DOI：
10.1177/15648265140352s105
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发表时间：
2014-06-01
影响因子：
1.9
通讯作者：
Amadi, Beatrice
中科院分区：
文献类型：
--
作者：
Maleta, Kenneth;Amadi, Beatrice
背景最近以社区为基础的急性营养不良管理（CMAM）的成功激发了人们对如何在保持治疗结果的同时提高覆盖率的兴趣。作为案例研究，记录马拉维、加纳和赞比亚这三个非洲国家在扩大CMAM方面的经验。利用已公布和未公布的数据以及国家方案数据和主要知情人访谈进行案头审查。这三个国家启动的动机各不相同，但至少在其政策和战略文件中，都成功地将CMAM纳入了5岁以下儿童的基本保健一揽子计划。卫生部的强有力领导发挥了重要作用，并得到了主要利益攸关方和捐助伙伴的补充。实施情况各不相同，取决于该方案何时推出，马拉维实现了最大程度的融合，其次是加纳和赞比亚。通过使用CMAM，这三个国家显著扩大了服务覆盖面，改善了治疗效果，治愈率从加纳的73%到马拉维的90%不等，同时保持了非常低的死亡率：马拉维为1.7%，加纳为2%，赞比亚为5%。CMAM是一个可行的选择，以改善服务覆盖面和成果的卫生系统，住院治疗护理本身是不够的。
Background. Recent success with community-based management of acute malnutrition (CMAM) has spurred interest on how to improve coverage while maintaining treatment outcomes.Objective. To document, as case studies, the experience of three African countries, Malawi, Ghana, and Zambia, in scaling up CMAM.Methods. Desk review using published and unpublished data and country programmatic data and key informant interviews.Results. All three countries, with different motivations for startup, have successfully integrated CMAM into their essential health packages for children under 5 years of age, at least in their policy and strategic documents. Strong leadership by the ministries of health has been instrumental, complemented by key stakeholders and donor partners. Implementation is at variable stages, depending on when the program rolled out, with Malawi having achieved the most integration, followed by Ghana and Zambia. Using CMAM, the three countries have significantly extended service coverage and improved treatment outcomes, with cure rates ranging from 73% in Ghana to 90% in Malawi, while maintaining very low death rates: 1.7% in Malawi, 2% in Ghana, and 5% in Zambia.Conclusions. CMAM is a viable option to improve service coverage and outcomes in health systems where inpatient therapeutic care alone cannot suffice.