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Article

Assessing the Impact of Integrated Community-Based Management of Severe Wasting Programs in Conflict-Stricken South Sudan: A Multi-Dimensional Approach to Scalability of Nutrition Emergency Response Programs

1
Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2560, Australia
2
Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC 3004, Australia
3
UNICEF South Sudan, Totto Chan Compound, Juba P.O. Box 45, Sudan
4
Nutrition Department, South Sudan Ministry of Health, Juba 81111, Sudan
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NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
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UNICEF Somalia, RA International Compound, Aden Adde International Airport Area, Mogadishu, Somalia
*
Author to whom correspondence should be addressed.
Academic Editor: Gabriel Gulis
Int. J. Environ. Res. Public Health 2021, 18(17), 9113; https://doi.org/10.3390/ijerph18179113
Received: 7 July 2021 / Revised: 16 August 2021 / Accepted: 26 August 2021 / Published: 29 August 2021
(This article belongs to the Special Issue Health of Migrant Children)
Community-based management of severe wasting (CMSW) programs have solely focused on exit outcome indicators, often omitting data on nutrition emergency preparedness and scalability. This study aimed to document good practices and generate evidence on the effectiveness and scalability of CMSW programs to guide future nutrition interventions in South Sudan. A total of 69 CMSW program implementation documents and policies were authenticated and retained for analysis, complemented with the analyses of aggregated secondary data obtained over five (2016–2020 for CMSW program performance) to six (wasting prevention) years (2014–2019). Findings suggest a strong and harmonised coordination of CMSW program implementation, facilitated timely and with quality care through an integrated and harmonised multi-agency and multidisciplinary approach. There were challenges to the institutionalisation and ownership of CMSW programs: a weak health system, fragile health budget that relied on external assistance, and limited opportunities for competency-based learning and knowledge transfer. Between 2014 and 2019, the prevalence of wasting fluctuated according to the agricultural cycle and remained above the emergency threshold of 15% during the July to August lean season. However, during the same period, under-five and crude mortality rates (10,000/day) declined respectively from 1.17 (95% confidence interval (CI): 0.91, 1.43) and 1.00 (95% CI: 0.75, 1.25) to 0.57 (95% CI: 0.38, 0.76) and 0.55 (95% CI: 0.39, 0.70). Both indicators remained below the emergency thresholds, hence suggesting that the emergency response was under control. Over a five-year period (2016–2020), a total of 1,105,546 children (52% girls, 48% boys) were admitted to CMSW programs. The five-year pooled performance indicators (mean [standard deviations]) was 86.4 (18.9%) for recovery, 2.1 (7.8%) for deaths, 5.2 (10.3%) for defaulting, 1.7 (5.7%) for non-recovery, 4.6 (13.5%) for medical transfers, 2.2 (4.7%) for relapse, 3.3 (15.0) g/kg/day for weight gain velocity, and 6.7 (3.7) weeks for the length of stay in the program. In conclusion, all key performance indicators, except the weight gain velocity, met or exceeded the Humanitarian Charter and Minimum Standards in Humanitarian Response. Our findings demonstrate the possibility of implementing robust and resilient CMSAM programs in protracted conflict environments, informed by global guidelines and protocols. They also depict challenges to institutionalisation and ownership. View Full-Text
Keywords: South Sudan; community-based management of severe wasting; effectiveness of treatment; relapse South Sudan; community-based management of severe wasting; effectiveness of treatment; relapse
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MDPI and ACS Style

Renzaho, A.M.N.; Dachi, G.; Tesfaselassie, K.; Abebe, K.T.; Kassim, I.; Alam, Q.; Shaban, N.S.; Shiweredo, T.; Vinathan, H.; Jaiswal, C.; Abraham, H.M.; Miluwa, K.A.; Mahumud, R.A.; Ategbo, E.; Ndiaye, B.; Ayoya, M.A. Assessing the Impact of Integrated Community-Based Management of Severe Wasting Programs in Conflict-Stricken South Sudan: A Multi-Dimensional Approach to Scalability of Nutrition Emergency Response Programs. Int. J. Environ. Res. Public Health 2021, 18, 9113. https://doi.org/10.3390/ijerph18179113

AMA Style

Renzaho AMN, Dachi G, Tesfaselassie K, Abebe KT, Kassim I, Alam Q, Shaban NS, Shiweredo T, Vinathan H, Jaiswal C, Abraham HM, Miluwa KA, Mahumud RA, Ategbo E, Ndiaye B, Ayoya MA. Assessing the Impact of Integrated Community-Based Management of Severe Wasting Programs in Conflict-Stricken South Sudan: A Multi-Dimensional Approach to Scalability of Nutrition Emergency Response Programs. International Journal of Environmental Research and Public Health. 2021; 18(17):9113. https://doi.org/10.3390/ijerph18179113

Chicago/Turabian Style

Renzaho, Andre M.N., Gilbert Dachi, Kibrom Tesfaselassie, Kiross T. Abebe, Ismail Kassim, Qutab Alam, Nawal S. Shaban, Tesfatsion Shiweredo, Hari Vinathan, Chandrakala Jaiswal, Hellen M. Abraham, Khamisa A. Miluwa, Rashidul A. Mahumud, Eric Ategbo, Biram Ndiaye, and Mohamed A. Ayoya. 2021. "Assessing the Impact of Integrated Community-Based Management of Severe Wasting Programs in Conflict-Stricken South Sudan: A Multi-Dimensional Approach to Scalability of Nutrition Emergency Response Programs" International Journal of Environmental Research and Public Health 18, no. 17: 9113. https://doi.org/10.3390/ijerph18179113

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