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Open AccessArticle

Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia

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Department of Biomedicine and Prevention, University of Rome Tor Vergata, via Montpellier, Rome 00133, Italy
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Rainbow Project Association Pope John 23rd, 5656 Chinika Road, Ndola 10101, Zambia
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Ndola District Health Office, 1307 Naidu Close, Ndola 10101, Zambia
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Department of Pediatrics, David Geffen UCLA School of Medicine School of Medicine, Los Angeles, CA 90095, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(9), 1807; https://doi.org/10.3390/ijerph15091807
Received: 1 June 2018 / Revised: 10 August 2018 / Accepted: 12 August 2018 / Published: 22 August 2018
Background: Child malnutrition, in all its forms, is a public health priority in Zambia. After implementations based on a previous evaluation in 2012–14 were made, the efficacy of the Rainbow Project Supplementary Feeding Programs (SFPs) for the integrated management of severe acute malnutrition (SAM), moderate acute malnutrition (MAM), and underweight was reassessed in 2015–17. Methods: The outcomes were compared with International Standards and with those of 2012–14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: The data for 900 under-five year-old malnourished children were analyzed. Rainbow’s 2015–17 outcomes met International Standards, for total and also when stratified for different type of malnutrition. A better performance than 2012–14 was noted in the main areas previously identified as critical: mortality rates were halved (5.6% vs. 3.1%, p = 0.01); significant improvements in average weight gain and mean length of stay were registered for recovered children (p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ <–3 (4.6; 1.3–16.1), and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Secondly, training community volunteers consistently increased the awareness of a child’s HIV status (+30%; p < 0.001). Conclusion: Rainbow SFPs provide an integrated community-based approach for the treatment and prevention of child malnutrition in Zambia, with its effectiveness significantly enhanced after the gaps in activities were filled. View Full-Text
Keywords: child malnutrition; community-based management of acute malnutrition—CMAM; moderate acute malnutrition—MAM; severe acute malnutrition—SAM; supplementary feeding programs—SFP; underweight; Zambia child malnutrition; community-based management of acute malnutrition—CMAM; moderate acute malnutrition—MAM; severe acute malnutrition—SAM; supplementary feeding programs—SFP; underweight; Zambia
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Moramarco, S.; Amerio, G.; Kasengele Chipoma, J.; Nielsen-Saines, K.; Palombi, L.; Buonomo, E. Filling the Gaps for Enhancing the Effectiveness of Community-Based Programs Combining Treatment and Prevention of Child Malnutrition: Results from the Rainbow Project 2015–17 in Zambia. Int. J. Environ. Res. Public Health 2018, 15, 1807.

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