에티오피아의 중증급성영양실조(SAM) 치료 범위 확대 (R-SWITCH)

• Usual screening of wasting by health extension workers (HEW) using MUAC
• Previous introduction of Family-led MUAC (not maintained)
• Behavior Change Communication (BCC) offered by Health extension worker (low intensity)
• Treatment of SAM at health post or health center
• Follow-up of SAM OTP defaults through home visits by HEW (very low intensity)

1. Monthly group meetings of AFD community groups
2. Introduction of weight-for-age Z-score <-3 as an additional screening criterion
3. Promotion of Family-led MUAC screening and SAM awareness to fathers, community and religious leaders
4. Follow-up and counselling during home visits by AFD leaders
5. Strengthening communication between HEW and AFDs

1. Monthly group meetings of Alliance for Development (AFD) community groups) and their members (caregivers of children 0-59 months of age):

   • Introduction and refresher of Family-led MUAC
   • Active screening of wasting by AFD
   • Group SBCC on Infant and Young Child Feeding (IYCF), health and Water, Sanitation and Hygiene (WaSH) with a focus on SAM
   • Promotion of health services such as GMP

2. Introduction of weight-for-age Z-score <-3 as screening criterion for passive screening by health extension workers at any contact with children (e.g. during GMP)

3. Promotion of Family-led MUAC screening and SAM awareness to fathers during male agricultural/pastoralist extension activities and by community and religious leaders (creating social support)

4. Follow-up and counselling during home visits by AFD leaders of i) earlier referred cases of SAM, ii) cases enrolled in SAM OTP, iii) and recovered SAM cases discharged from OTP

5. Strengthening communication between HEW and AFDs

Defined as the proportion of children with Severe Acute Malnutrition (SAM) or enrolled in the SAM Outpatient Therapeutic program (OTP) that are "under treatment".

• SAM is defined as a Mid-Upper Arm Circumference <115mm or a weight-for-height Z-score <-3 (relative to the World Health Organization (WHO) 2006 growth standards) or presence of bilateral pitting edema.

• "Under treatment" is defined as:

  • the caregiver acknowledging the child is enrolled in a SAM OTP AND
  • the child was fed ready-to-use therapeutic food (RUTF) over the last three days AND
  • the caregiver can either show at least one full RUTF sachet OR more than one empty RUTF sachet.

Defined as the proportion of children with SAM at the time of the survey that are under treatment (see definition under primary outcome

Defined as the proportion of children with Severe Acute Malnutrition (SAM) or Severe underweight (weight-for-age Z-score <-3) or enrolled in the SAM Outpatient Therapeutic program (OTP) that are "under treatment".

• SAM is defined as a Mid-Upper Arm Circumference <115mm or a weight-for-height Z-score <-3 (relative to the WHO 2006 growth standards) or presence of bilateral pitting edema.

• "Under treatment" is defined as:

  • the caregiver acknowledging the child is enrolled in a SAM OTP AND
  • the child was fed ready-to-use therapeutic food (RUTF) over the last three days AND
  • the caregiver can either show at least one full RUTF sachet OR more than one empty RUTF sachet.

Defined as the proportion of children aged 6-59 months with SAM screened for wasting over the last 30 days (as reported by the caregiver)

Defined as the proportion of children aged 6-59 months with severe underweight (weight-for-age Z-score <-3 relative to WHO 2006 growth standard) screened over the last 30 days (as reported by the caregiver)

Defined as the proportion of children aged 6-59 months with SAM screened for wasting over the last 30 days (as reported by the caregiver):

• by Family-led MUAC ( screening by family members using a MUAC tape)
• during growth monitor promotion (GMP) consultations
• during Integrated management of childhood illness consultations

Defined as the proportion of children aged 6-59 months with SAM that attended GMP over the last 30 days (as reported by the caregiver).

Defined as the proportion of of children aged 6-59 months with SAM that attended the monthly AFD group contact over the last 30 days (as reported by the caregiver).

Defined as the proportion of children aged 6-59 months with SAM and children enrolled in SAM OTP that received a home visit by an AFD leader/member over the last 30 days (as reported by the caregiver).

Defined as the proportion of children aged 6-59 months with SAM (defined as WHZ <-3 or a MUAC < 115 mm or the presence of bilateral pitting edema). To calculate WHZ scores the 2006 WHO growth reference will be used

Defined as the proportion of children aged 6-59 months with wasting (defined as WHZ <-2 or a MUAC < 125 mm or the presence of bilateral pitting edema). To calculate WHZ scores the 2006 WHO growth reference will be used

Defined as the proportion of children aged 6-59 months with stunting (defined as height-for-age Z-scores (HAZ) <-2 or a MUAC < 125 mm or the presence of bilateral pitting edema). To calculate HAZ scores the 2006 WHO growth reference will be used

Defined as the proportion of children aged 6-59 months with underweight (defined as weight-for-age Z-scores (WAZ) <-2 ) and severe underweight (defined as WAZ <-3 ). To calculate WAZ scores the 2006 WHO growth reference will be used

In 6-59 months old children. To calculate HAZ scores the 2006 WHO growth reference will be used

In 6-59 months old children.To calculate WHZ scores the 2006 WHO growth reference will be used

In 6-59 months old children.To calculate WAZ scores the 2006 WHO growth reference will be used

In 6-59 months old children.

Presented as a total standardized score and by knowledge domain

Proportion of children aged 6-18 months with SAM or enrolled in SAM OTP who received all age-recommended immunizations

The proportion of children 6-8 months of age who consumed (semi) solid and soft complementary foods during the previous day

The proportion of study children aged 6-23 months who consumed at least 5 of the 8 food groups (including breast milk) during the previous day

The mean number of food groups consumed during the previous day by study children aged 6-59

Defined as the proportion of study children who had eaten during the previous day: 2 meals for breastfed children 6-8 months, 3 meals for breastfed children 9-23 months, or 4 meals for non-breastfed children 6-23 monthsMinimum meal frequency for children, defined as the proportion of children who had eaten the day before the survey: 2 meals for breastfed children 6-8 months, 3 meals for breastfed children 9-23 months, or 4 meals for non-breastfed children 6-23 months.

Defined as the proportion of study children aged 6-23 months with both minimal dietary diversity and minimal meal frequency during the previous day

Defined as the proportion of children aged 12-23 months breastfed during the previous day

Proportion of children 6-23 months of age who consumed egg and/or flesh food during the previous day

Proportion of children 6-23 months of age who consumed a sweet beverage during the previous day

Proportion of children 6-23 months of age who did not consume any vegetables or fruits during the previous day

Proportion of non-breastfed children 6-23 months of age who consumed at least two milk feeds during the previous day

Weight-for-length Z-score (relative to the 2006 WHO reference) and MUAC(mm)

Defined as the proportion of cases enrolled to SAM OTP who received timely treatment from dedicated services (health center or health post) until anthropometric recovery

Defined as the weight gain during SAM OTP divided by the length of treatment and divided by the child's weight

Among cases admitted to SAM OTP

Defined as the number of days spent in SAM OTP (from admission to discharge)