COVERAGE AND BARRIERS TO ACCESS FOR SEVERE ACUTE MALNUTRITION (SAM) SERVICES IN THE TAMALE METROPOLIS OF NORTHERN REGION

Abstract

Malnutrition remains a major public health problem throughout the developing world. For many decades, the only effective treatment for children with Severe Acute Malnutrition (SAM) was based primarily on Inpatient Care. The treatment approach however changed with the introduction of the community-based management of acute malnutrition (CMAM) where a ready-to-use therapeutic food (RUTF) is used. A cross-sectional study was conducted using Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC), a twostage sample in the Tamale Metropolis to assess the coverage and barriers to access for SAM treatment services. A mixture of quantitative and qualitative data collection techniques was used. Interviews were conducted among caregivers of children 6-59 months with SAM and service providers (CMAM facilities) while focus group discussions were held among key opinion leaders in four (4) selected communities. The quantitative data was analyzed using SPSS (version 18.0) using the LQAS (Lot Quality Assurance) principles, while the qualitative data was analyzed manually based on thematic areas. Bivariate analysis was done to determine the association between selected factors and uptake of CMAM services. A total of 24 communities were randomly selected for the study and 173 children aged 6-59 months were screened, out of which 12.1% were suffering from SAM. CMAM coverage was found to be 38.1%; described as moderate. Lack of child care/help with children, health facility is too far away, lack of means of transport to OPC sites, financial constraints, ignorance of the CMAM programme, needed to be referred but there is no one to do this, previous rejection of sibling and shortage of Ready-to-use therapeutic food were reported as barriers to access to SAM treatment by respondents. Lack of child care/help with children was identified as the only socio-economic factor that had significant association with uptake of CMAM services (p=0.007). Overall, mothers’ knowledge on CMAM service was found to be 50%. Quality of CMAM services in the Metropolis was also found to be poor. The Tamale Metropolitan Health Directorate should therefore task all health staff to conduct periodic active case search to improve coverage and ensure early detection and treatment of SAM cases and also train all staff rendering services on the CMAM module.