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      Perceptions towards management of acute malnutrition by community health volunteers in northern Kenya

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          Abstract

          Child undernutrition is a persistent challenge in arid and semi-arid areas due to low and erratic rainfall, recurrent droughts and food insecurity. In these settings, caregivers face several challenges in accessing health services for sick and/or malnourished children, including long distances to health facilities, harsh terrain, and lack of money to pay for transportation costs to the health facilities, leading to low service coverage and sub-optimal treatment outcomes. To address these challenges and optimize treatment outcomes, the World Health Organization recommends utilizing community health volunteers (CHVs) to manage acute malnutrition in the community. This study explored the perceptions of community members regarding acute malnutrition treatment by CHVs in Turkana and Isiolo counties in Kenya. The study utilized a cross-sectional study design and included a purposive sample of caregivers of children, CHVs, officers who trained and supervised CHVs and community leaders in the intervention area. Focus group discussions and key informant interviews were used to explore perceptions towards the management of acute malnutrition by CHVs. Generally, caregivers and CHVs perceived the intervention to be beneficial as it readily addressed acute malnutrition treatment needs in the community. The intervention was perceived to be acceptable, effective, and easily accessible. The community health structure provided a platform for commodity supply and management and CHV support supervision. This was a major enabler in implementing the intervention. The intervention faced operational and systemic challenges that should be considered before scale-up.

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Child malnutrition in sub-Saharan Africa: A meta-analysis of demographic and health surveys (2006-2016)

            Background Sub-Saharan Africa has one of the highest levels of child malnutrition globally. Therefore, a critical look at the distribution of malnutrition within its sub-regions is required to identify the worst affected areas. This study provides a meta-analysis of the prevalence of malnutrition indicators (stunting, wasting and underweight) within four sub-regions of sub-Saharan Africa. Methods Cross-sectional data from the most recent Demographic and Health Surveys (2006–2016) of 32 countries in sub-Saharan Africa were used. The countries were grouped into four sub-regions (East Africa, West Africa, Southern Africa and Central Africa), and a meta-analysis was conducted to estimate the prevalence of each malnutrition indicator within each of the sub-regions. Significant heterogeneity was detected among the various surveys (I2 >50%), hence a random effect model was used, and sensitivity analysis was performed, to examine the effects of outliers. Stunting was defined as HAZ<-2; wasting as WHZ<-2 and underweight as WAZ<-2. Results Stunting was highest in Burundi (57.7%) and Malawi (47.1%) in East Africa; Niger (43.9%), Mali (38.3%), Sierra Leone (37.9%) and Nigeria (36.8%) in West Africa; Democratic Republic of Congo (42.7%) and Chad (39.9%) in Central Africa. Wasting was highest in Niger (18.0%), Burkina Faso (15.50%) and Mali (12.7%) in West Africa; Comoros (11.1%) and Ethiopia (8.70%) in East Africa; Namibia (6.2%) in Southern Africa; Chad (13.0%) and Sao Tome & Principle (10.5%) in Central Africa. Underweight was highest in Burundi (28.8%) and Ethiopia (25.2%) in East Africa; Niger (36.4%), Nigeria (28.7%), Burkina Faso (25.7%), Mali (25.0%) in West Africa; and Chad (28.8%) in Central Africa. Conclusion The prevalence of malnutrition was highest within countries in East Africa and West Africa compared to the WHO Millennium development goals target for 2015. Appropriate nutrition interventions need to be prioritised in East Africa and West Africa if sub-Saharan Africa is to meet the WHO global nutrition target of improving maternal, infant and young child nutrition by 2025.
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              Malnutrition in Sub – Saharan Africa: burden, causes and prospects

              Malnutrition is estimated to contribute to more than one third of all child deaths, although it is rarely listed as the direct cause. Contributing to more than half of deaths in children worldwide; child malnutrition was associated with 54% of deaths in children in developing countries in 2001. Poverty remains the major contributor to this ill. The vicious cycle of poverty, disease and illness aggravates this situation. Grooming undernourished children causes children to start life at mentally sub optimal levels. This becomes a serious developmental threat. Lack of education especially amongst women disadvantages children, especially as far as healthy practices like breastfeeding and child healthy foods are concerned. Adverse climatic conditions have also played significant roles like droughts, poor soils and deforestation. Sociocultural barriers are major hindrances in some communities, with female children usually being the most affected. Corruption and lack of government interest and investment are key players that must be addressed to solve this problem. A multisectorial approach is vital in tackling this problem. Improvement in government policy, fight against corruption, adopting a horizontal approach in implementing programmes at community level must be recognized. Genetically modified foods to increase food production and to survive adverse climatic conditions could be gateways in solving these problems. Socio cultural peculiarities of each community are an essential base line consideration for the implementation of any nutrition health promotion programs.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: Writing – original draft
                Role: Formal analysisRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administration
                Role: Data curationRole: Formal analysisRole: Methodology
                Role: Project administration
                Role: InvestigationRole: MethodologyRole: Project administration
                Role: Project administration
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administration
                Role: ConceptualizationRole: MethodologyRole: Supervision
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: Supervision
                Role: ConceptualizationRole: Methodology
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: Methodology
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Methodology
                Role: ConceptualizationRole: Project administration
                Role: ConceptualizationRole: Methodology
                Role: ConceptualizationRole: Methodology
                Role: ConceptualizationRole: Project administrationRole: Supervision
                Role: ConceptualizationRole: MethodologyRole: Supervision
                Role: MethodologyRole: Project administration
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                16 May 2024
                2024
                : 4
                : 5
                : e0002564
                Affiliations
                [1 ] African Population and Health Research Center, Nairobi, Kenya
                [2 ] The World Bank Health Nutrition and Population Global Practice, Washington, DC, United States of America
                [3 ] International Food Policy Research Institute, Addis Ababa, Ethiopia
                [4 ] UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya
                [5 ] UNICEF Kenya County Office, Nairobi, Kenya
                [6 ] Ministry of Health, Nairobi, Kenya
                [7 ] Action Against Hunger, London, United Kingdom
                [8 ] Save the Children UK, London, United Kingdom
                [9 ] Save the Children International, Nairobi, Kenya
                [10 ] World Health Organization, Kenya Country Office, Nairobi, Kenya
                PLOS: Public Library of Science, UNITED STATES
                Author notes

                The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-3238-0349
                https://orcid.org/0000-0002-6606-6534
                https://orcid.org/0000-0002-4491-538X
                https://orcid.org/0000-0002-0612-7251
                https://orcid.org/0000-0003-4784-5003
                https://orcid.org/0009-0005-6977-1457
                Article
                PGPH-D-23-01150
                10.1371/journal.pgph.0002564
                11098467
                38753839
                c501ed22-6ad4-49ab-87b9-86f522196041
                © 2024 Wambui et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 June 2023
                : 18 April 2024
                Page count
                Figures: 0, Tables: 2, Pages: 19
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100006641, UNICEF;
                Award ID: 43229187
                Award Recipient :
                The study was funded by United Nations Children's Fund (UNICEF) Kenya, https://www.unicef.org/kenya/ Contract number 43229187 Awarded to EK-M. The funder had no role in the design, data collection, analysis, decision to publish or preparation of the manuscript.
                Categories
                Research Article
                Biology and Life Sciences
                Nutrition
                Malnutrition
                Medicine and Health Sciences
                Nutrition
                Malnutrition
                Medicine and Health Sciences
                Health Care
                Caregivers
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Medicine and Health Sciences
                Pediatrics
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Child Health
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                Biology and Life Sciences
                Ecology
                Community Ecology
                Community Structure
                Ecology and Environmental Sciences
                Ecology
                Community Ecology
                Community Structure
                Medicine and Health Sciences
                Pulmonology
                Pneumonia
                Custom metadata
                In line with African Population and Health Research Center's data sharing policy, data underlying the findings of this study will be made freely available on request from the APHRC through the Microdata portal ( https://aphrc.org/microdata-portal/). This study does not contain any data obtained from a third party. Data used is owned by the researchers and by extension, APHRC. There are no ethical or legal restriction to sharing the de-identified data set supporting our manuscript submitted.

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