Action Against Hunger USA, Washington, DC, USA.
UNICEF, New York, New York, USA.
Matern Child Nutr. 2022 Oct;18(4):e13406. doi: 10.1111/mcn.13406. Epub 2022 Aug 5.
The COVID-19 pandemic presented numerous challenges to acute malnutrition screening and treatment. To enable continued case identification and service delivery while minimising transmission risks, many organisations and governments implemented adaptations to community-based management of acute malnutrition (CMAM) programmes for children under 5. These included: Family mid-upper arm circumference (MUAC); modified admission and discharge criteria; modified dosage of therapeutic foods; and reduced frequency of follow-up visits. This paper presents qualitative findings from a larger mixed methods study to document practitioners' operational experiences and lessons learned from these adaptations. Findings reflect insights from 37 interviews representing 15 organisations in 17 countries, conducted between July 2020 and January 2021. Overall, interviewees indicated that adaptations were mostly well-accepted by staff, caregivers and communities. Family MUAC filled screening gaps linked to COVID-19 disruptions; however, challenges included long-term accuracy of caregiver measurements; implementing an intervention that could increase demand for inconsistent services; and limited guidance to monitor programme quality and impact. Modified admission and discharge criteria and modified dosage streamlined logistics and implementation with positive impacts on staff workload and caregiver understanding of the programme. Reduced frequency of visits enabled social distancing by minimising crowding at facilities and lessened caregivers' need to travel. Concerns remained about how adaptations impacted children's identification for and progress through treatment and programme outcomes. Most respondents anticipated reverting to standard protocols once transmission risks were mitigated. Further evidence, including multi-year programmatic data analysis and rigorous research, is needed in diverse contexts to understand adaptations' impacts, including how to ensure equity and mitigate unintended consequences.
COVID-19 大流行给急性营养不良筛查和治疗带来了诸多挑战。为了在尽量降低传播风险的同时继续发现病例和提供服务，许多组织和政府对面向 5 岁以下儿童的社区急性营养不良管理（CMAM）方案进行了调整。这些调整包括：家庭上臂中部周长（MUAC）；调整入院和出院标准；调整治疗食品剂量；减少随访次数。本文从一项更大的混合方法研究中提取定性研究结果，以记录从业人员在实施这些调整方面的业务经验和教训。研究结果反映了 2020 年 7 月至 2021 年 1 月期间对来自 17 个国家/地区的 15 个组织的 37 次访谈中获得的见解。总体而言，受访者表示，这些调整大多得到了工作人员、照料者和社区的认可。家庭 MUAC 填补了与 COVID-19 相关的筛查空白；然而，也存在一些挑战，包括照料者测量的长期准确性、实施可能增加对不一致服务需求的干预措施，以及缺乏监测方案质量和影响的指导。调整入院和出院标准以及调整剂量简化了后勤工作，对工作人员工作量和照料者对方案的理解产生了积极影响。减少访问次数有助于通过尽量减少设施拥挤和减少照料者的出行需求来实现社交距离。人们仍然担心这些调整如何影响儿童的治疗和方案结局的识别和进展。大多数受访者预计一旦传播风险得到缓解，就会恢复标准方案。需要在不同背景下进一步开展证据收集，包括多年的方案数据分析和严格的研究，以了解调整的影响，包括如何确保公平性和减轻意外后果。
