Performance of Community- based

Management of Acute Malnutrition

programme and its impact on
nutritional status of children under
five years of age in Malawi. A case of
Lilongwe Rural

MSc Research Proposal

Presented by :Alice Nyasulu
Supervisor: Dr A.M Mwangi
Date: 19th April 2012
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 Background Information
Malnutrition is the major problem in
developing countries.
Contributes over 50% of the 10 - 11 million
deaths from preventable causes, globally-
PEM is the main cause
The recommendation was to refer SAM
children to hospital to receive therapeutic
diets along with medical care-reduced case
fatality by 55%.(WHO 2010).
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 Background cont
Recent advent of ready to use
therapeutic foods (RUTF) allowed the
management of SAM in the
community
Malawi being one of the poor
countries it became among the first
to adopt home based approach of
treating malnourished children.
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Problem Statement
Since inception of Communitybased
management of under five children with
acute malnutrition in Lilongwe in 2006
its impact has not been assessed.
Justification
Implementation of CMAM involves
utilization of scares resources it is
important to determine whether the
resources spent are bringing about
expected results.
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Study Aim
To contribute to the improvement of the
nutritional status of under five children in
Malawi.
Study purpose
To provide information useful in ensuring
that the programme is meeting its
objectives through re-alignment of
activities in line with the findings.

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Main Objective
To assess performance of CMAM and its impact on the
nutritional status of children under five years in Lilongwe
rural.
Specific Objective
To determine the socio economic and demographic
status of the study household
To determine the trend of nutritional status of under
five children in the programme area.
To determine the level of coverage of CMAM program
compared to programme target.
To establish the quality of service delivery for the
programme.
To establish whether there is an association between the
nutritional status and the socio economic status of the
household under study.
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Research Questions
What are the social demographic
characteristics of the population under study?
What is the trend of the nutrional status of
under five children in Lilongwe rural?
What type of CMAM services are being
offered in the study area?
What is the coverage of CMAM in the study
area?
What is the influence of social economic
status on the nutritional status of under five
children in the study area?
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 Hypotheses

The community-based management has

significantly improved nutritional status
of under-five children in Lilongwe rural.

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 LITERATURE REVIEW

2.0 LITERATURE REVIEW

2.1 History of CMAM
2.1.2 Causes of Malnutrition
2.2 Traditional Treatment of Acute Malnutrition
2.3 Community-based Management of Acute
Malnutrition
2.3.1 Case detection at community level
2.3.2 Community Mobilization
2.4 Knowledge Gap

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 Knowledge Gap

.
Although community based management
has been identified as one of effective
management of malnutrition, it has been
hit by many problems ranging from
insufficient RUTF and not being cost
effective.

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 METHODOLOGY
Study site
Lilongwe rural in the central region of
Malawi
In four randomly selected Traditional
Authorities
Study population
Households with children 6-59 months
Mothers/caretakers will be the respondent
Study design
Cross-section with retrospective component.
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 Sample size determination
Fisher et al (1991)
n= Z2 pq/d2
Z= Level of significant = 1.962
p= Prevalence of indicators= 0.061(6.1%)
q= 1-p
d2=Degree of Precision = 0.052
n = 1.962 x 0.061 (1-0.061)
0.052
n=88.01
n= 88
Minimum sample size
Sample size of 200

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Sampling Procedure

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 Inclusion and exclusion criteria
Measuring unit
Children from 6-56 months old.
Beneficiaries and non beneficiaries

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 Study tools and equipment
The following will be used
Questionnaire to collect data on
Socio demographic
Socio-economic
Health workers level of skill
Quality and quantity of equipment/ supplies
Anthropometric equipment
- Salter Scales
-Length/height board
-MUAC tape
Clinical observation
Key informant-will be used to obtain qualitative data
on child care practices
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 Data collection
Recruitment of field assistants with nutritional
knowledge or hospital working experience
Training of the field assistants and pre-testing
of the questionnaire
Re-calibration of scales on daily basis to
ensure data acurancy.
Checking equipment availability and
adequacy.
Anthropometric measurement of under five
children
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 Data management and Analysis
Data entry using SPSS computer
packages and micro-soft excel
Data cleaning and checking of outliers
Data analysis using SPSS computer
packages and microsoft excel

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 Variables to be analysed
Demographic characteristics
Sex and age range
Age and sex distribution
Education levels of caregivers
Main source of income
Nutrition status of under-five children
Height
Weight
MUAC
Child in programme or not
CMAM Services
Flow of supply
Equipment availability
Knowledge and skills for service providers
Association between socio-economic status and nutrition status.

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 BUDGET
ACTIVITIES ITEM DESCRIPTION DAYS UNIT COST QUANTITY TOTAL
Training 1)Enumerators 1 1,000 2 2,000
2)stationary 1 1,500 1 1,500
3)other training material 1 1,000 3 3,000
4)Reseacher 1 2,000 1 2,000
5)Food 1 250 5 1,250

Community
mobilization 1)reseacher 1 1,000 1 1,000
2)field assistance 1 500 2 1,000
3)Community leaders 1 500 4 2,000
Survey 1) Equipment 7 1,000 3 21,000
2)reseacher 7 2,000 1 14,000
3)field Assistants 7 1,000 3 21,000
4) fuel 7 2,000 1 14,000
5)Stationary 7 2,500 1 17,500

Supervision 1)Airtickect 1 69,700 1 69,700

2)Per diem 3 20,500 1 61,500
TOTAL 232,450

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