Assessment of acute malnutrition screening coverage among children aged 6–59 months: Evidence from a community-based representative survey in Ethiopia

Abstract

BACKGROUND: Acute malnutrition remains a major public health concern in Ethiopia, yet gaps in screening coverage hinder early detection and timely management. Through Community-based Management of Acute Malnutrition (CMAM) and its expanded Integrated Management of Acute Malnutrition (IMAM) program, Ethiopia prioritized community-level screening and referral. However, progress toward achieving full and equitable screening coverage remains limited. OBJECTIVE: This study aimed to estimate the coverage of acute malnutrition screening among children aged 6-59 months in Ethiopia and to compare the screening levels between districts implementing the Integrated Management of Acute Malnutrition (IMAM) program and those not implementing it the program and further evaluate the independent effect of IMAM program implementation on screening coverage after controlling for potential confounders. METHODS: A comparative cross-sectional study was conducted between June and July 2023. 1,440 children between the ages of 6 -59 months from twelve districts, six of which were implementing the IMAM program and six of which were non IMAM districts were included in the study. Study participants in both IMAM-implementing and non-IMAM districts were selected using a multistage cluster sampling method. Screening coverage was estimated as the proportion of children screened for acute malnutrition out of the total eligible population surveyed. RESULTS: Overall screening coverage over the past three months was 52.8% among children under five. Screening coverage was significantly higher in IMAM-implementing districts compared with non-IMAM districts (56.3% Vs. 38.1%, P<0.001). In multivariable logistic regression analysis, children in IMAM-implementing districts had 61% higher odds of being screened compared to those in non-IMAM districts (AOR = 1.61, 95% CI: 1.25-2.08, p < 0.001). CONCLUSION: Screening coverage for acute malnutrition remains low in Ethiopia, with marked differences between IMAM-implementing and non-IMAM districts. IMAM implementation resulted in significantly higher screening coverage among children.