Improving the quality of care for children with acute malnutrition in Uganda
The study evaluated the impact of supportive supervision for health staff and whether it improved health outcomes of malnourished children
Abstract
The prevalence of moderate and severe acute malnutrition in children in Arua (a refugee-hosting district in Uganda’s West Nile region) is higher than in other areas of Uganda, and only 50% of malnourished children treated at health centres in the district are cured.
This study explored the effectiveness of supportive supervision of health centre staff in improving health outcomes for children with malnutrition. In the health centres receiving supportive supervision, the cure rate was significantly higher than in the control facilities (83.8% [95% CI: 71.0–96.6] versus 44.9% [95% CI: 38.2–51.6]). Diagnosis, treatment with ready-to-use therapeutic foods, HIV evaluation, counselling and assignment of the exit outcomes were correctly performed in most cases in both groups. However, complementary treatment was correctly assigned only in 58.8 per cent (95% CI: 43.2–74.3) of control facilities, compared with 94 per cent (95% CI: 83.7–100) of intervention facilities. At baseline, all facilities except one scored either poor or fair in any of the 10 nutrition assessment areas of the national tool, without significant difference between the intervention and control groups. At the end of the study period, both groups had increased the number of areas scoring either good or excellent, with a significant difference between the intervention and control arms (24 / 30 [80%] versus 14 / 30 [46.6%]). Supportive supervision is an effective intervention to improve the overall cure rate and quality of care; quality of case management; and access to care of malnourished children, in a low-resource outpatient setting.
This report is an output from the Department for International Development’s ‘Humanitarian Innovation and Evidence Programme: greater use of evidence and innovation in humanitarian responses’.
Citation
Marzia, L, Wanzira, H, Lochoro, P and Putoto, G, 2019. Improving the quality of care for children with acute malnutrition in Uganda, 3ie Impact Evaluation Report 101. New Delhi: International Initiative for Impact Evaluation (3ie). Available at: https://doi.org/10.23846/TW6IE101