Effective Coverage of Management of Wasting in Ethiopia

Abstract

Abstract Background Child wasting, or acute malnutrition, is a life-threatening condition that increases the risk of death and serious illness. Despite efforts such as the Global Action Plan on Child Wasting, which aims to reduce wasting prevalence to less than 3% by 2030, challenges persist, with Ethiopia recording a 7.2% rate. A major shortcoming of the global strategy is the focus on contact coverage, which often overlooks service quality. Effective coverage that incorporates the quality of health services offers a solution. Objective To assess the effective coverage of management of child wasting in six regions of Ethiopia. Data and Methods We conducted a secondary analysis of cross-sectional data obtained from household and institutional surveys. Participants included caregivers and children aged 6-59 months. By combining household data with expanded measures of health facility readiness and process quality from health posts, we calculated the quality-adjusted coverage. Results Contact coverage for severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) was 40% and 37%, respectively. Readiness scores for providing SAM and MAM services at health posts were 57.9% and 76.4%, respectively. The input-adjusted coverage for SAM and MAM, considering facility readiness, was 23% and 28%, respectively. The coverage adjusted for complete intervention receipt was 7% for SAM and 12% for MAM. Quality-adjusted coverage for both SAM and MAM was 4%. Conclusion Efforts to address acute malnutrition in the Ethiopian health system show commendable progress but also highlight critical gaps and inconsistencies. A holistic, quality-driven approach is needed to effectively combat child-wasting in Ethiopia. Strengths and limitations of this study Household surveys and facility data were concurrently collected within the same year. This allowed for an effective comparison between the readiness of facilities and services provided for acute malnutrition at that time. The selection of items for readiness and process quality was guided by WHO Service Availability and Readiness Assessment and the National Guideline for the Management of Acute Malnutrition. The study included only health posts in selected IMAM districts. This restricts the generalizability of the findings, as the care characteristics and quality at these excluded facilities might differ significantly. Although the health facility survey was extensive, it did not capture all the necessary data for a holistic calculation of the care cascade, particularly missing information needed for user adherence-adjusted coverage and outcome-adjusted coverage.