Lyles Emily, Banks Sandra, Ramaswamy Maya, Ismail Sule, Leidman Eva, Doocy Shannon
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
US Centers for Disease Control and Prevention, Atlanta, GA, USA.
BMC Nutr. 2023 Mar 11;9(1):46. doi: 10.1186/s40795-023-00696-y.
Globally, emergency nutrition program adaptations were implemented as part of COVID-19 mitigation strategies, but the implications of the adoption of all protocol changes at scale in the context of deteriorating food security are not yet well characterized. With ongoing conflict, widespread floods, and declining food security, the secondary impacts of COVID-19 on child survival in South Sudan is of great concern. In light of this, the present study aimed to characterize the impact of COVID-19 on nutrition programming in South Sudan.
A mixed methods approach including a desk review and secondary analysis of facility-level program data was used to analyze trends in program indicators over time and compare two 15-month periods prior to the onset of COVID-19 (January 2019 - March 2020; "pre-COVID period") and after the start of the pandemic (April 2020 - June 2021; "COVID" period) in South Sudan.
The median number of reporting Community Management of Acute Malnutrition sites increased from 1167 pre-COVID to 1189 during COVID. Admission trends followed historic seasonal patterns in South Sudan; however, compared to pre-COVID, declines were seen during COVID in total admissions (- 8.2%) and median monthly admissions (- 21.8%) for severe acute malnutrition. For moderate acute malnutrition, total admissions increased slightly during COVID (1.1%) while median monthly admissions declined (- 6.7%). Median monthly recovery rates improved for severe (92.0% pre-COVID to 95.7% during COVID) and moderate acute malnutrition (91.5 to 94.3%) with improvements also seen in all states. At the national level, rates also decreased for default (- 2.4% for severe, - 1.7% for moderate acute malnutrition) and non-recovery (- 0.9% for severe, - 1.1% for moderate acute malnutrition), with mortality rates remaining constant at 0.05-0.15%.
Within the context of the ongoing COVID-19 pandemic in South Sudan, improved recovery, default, and non-responder rates were observed following adoption of changes to nutrition protocols. Policymakers in South Sudan and other resource-constrained settings should consider if simplified nutrition treatment protocols adopted during COVID-19 improved performance and should be maintained in lieu of reverting to standard treatment protocols.
在全球范围内，紧急营养项目的调整作为新冠疫情缓解策略的一部分得以实施，但在粮食安全不断恶化的背景下大规模采用所有方案变更的影响尚未得到充分描述。由于冲突持续、洪水泛滥以及粮食安全状况不断下降，新冠疫情对南苏丹儿童生存的次生影响令人高度担忧。有鉴于此，本研究旨在描述新冠疫情对南苏丹营养项目的影响。
采用混合方法，包括案头审查和对机构层面项目数据的二次分析，以分析项目指标随时间的变化趋势，并比较南苏丹在新冠疫情爆发前（2019年1月至2020年3月；“新冠疫情前时期”）和疫情开始后（2020年4月至2021年6月；“新冠疫情时期”）的两个15个月时间段。
报告的社区急性营养不良管理点的中位数从新冠疫情前的1167个增加到新冠疫情期间的1189个。入院趋势遵循南苏丹的历史季节性模式；然而，与新冠疫情前相比，新冠疫情期间严重急性营养不良的总入院人数（-8.2%）和月入院中位数（-21.8%）有所下降。对于中度急性营养不良，新冠疫情期间总入院人数略有增加（1.1%），而月入院中位数下降（-6.7%）。严重急性营养不良（从新冠疫情前的92.0%提高到新冠疫情期间的95.7%）和中度急性营养不良（从91.5%提高到94.3%）的月恢复率中位数有所提高，所有州均有改善。在国家层面，失访率（严重急性营养不良为-2.4%，中度急性营养不良为-1.7%）和未康复率（严重急性营养不良为-0.9%，中度急性营养不良为-1.1%）也有所下降，死亡率保持在0.05-0.15%不变。
在南苏丹持续的新冠疫情背景下，采用营养方案变更后观察到恢复率、失访率和无反应率有所改善。南苏丹和其他资源有限地区的政策制定者应考虑新冠疫情期间采用的简化营养治疗方案是否提高了绩效，是否应维持该方案而非恢复到标准治疗方案。
