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Investigation period necessary for researching effect of sharing in MAM/SAM programming: Senegal

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Eric S. Anderson

Nutrition Advisor USAID FFP

Normal user

12 Jul 2016, 15:02

Advising a colleague working in Senegal and their question is this:

In the operating environment whereby there is a widespread program that is distributing PlumpySup to MAM cases to prevent SAM, how big of a factor is sharing in reducing the effectiveness of the intervention (i.e. should we spend limited time/resources on this issue)?

MAM cases are documented and PlumpySup distributed by operating organizations that do outreach. SAM cases are seen at a facility where they can be admitted into either inpatient or outpatient CMAM program.

So if we looked at the cases admitted at the facility (with SAM) and investigated whether they had been receiving the PlumpySup we could learn a bit about how important this issue is in the context where we already have the financial and institutional commitment to mobilize. Questions then are:

How many months of data (from the facilities) would be most useful to look at, knowing that a separate investigation has to take place with the operational partner organizations conducting the MAM part of the strategy?

Second, what would be a useful benchmark for determining the relative importance of the issue? If 10% of admitted cases have been ineffectively treated through the MAM/plumpySup strategy/20%/30% is that a problem?

Or is it best to go the other way, and try to explore the total MAM intervention group and look to see what percentage are appearing on the admissions list at the facility -- which would bring up the same question....what level would be a relative concern? 10%, 15%?

Thanks in advance for any thoughts, clarifying questions, comments or even answers!

Eric

Anonymous 525

Health and nutrition specialist

Normal user

12 Jul 2016, 18:57

Dear Eric,
These are very interesting questions I am concerned about as well, and for which I don't have so many answers. However, here are some general thoughts:

1) I am afraid it is difficult to isolate sharing from many potential confounds responsible for RUTF/RUSF program reduced effectiveness (i.e., acceptability, breastmilk displacement, adherence to administration messages like proper hygiene practices, which food to avoid when giving the product, storage conditions, etc.). Most authors I read rather formulated the problem as facilitators and barriers to home-based supplemental/therapeutic feeding, or simply described the use and acceptability of such products. Then, they used mixed methods to
--> first, point out these facilitators and barriers (qualitative), and second,
--> try to measure to which extent each of them exist (quantitative) or decide to focus on some of them.

Also, they tried to circumscribe their research to intra-household versus a broader dimension of sharing depending on their needs. Depending on what your colleague observes in Senegal, he/she can think about what suits best to the context.

2) Proportions: again, it may be very tricky to directly link the whole 10, 20 or 30% of ineffectively treated children to the unique presence of sharing practices because of the counfounds I was talking about. Hence, in my opinion, the question of which threshold to use as an alert unfortunately becomes quite challenging (to not say impossible) to address. As an alternative, UNHCR uses the benchmark of less than 25% of households reporting sharing as a program quality indicator within their M&E framework (see p89 of this document http://www.unhcr.org/4f1fc3de9.pdf). Of course, questionnaires must be designed properly and interviewers be well-trained in order to avoid respondent bias as much as possible. Also, I don't know how big are your programs, but I would also consider reporting counts. Indeed, 10% of 100 beneficiaries is 10 persons, but 10% of 10000 are 1000. Presenting both figures can help visualise the extent of the problem better and alert stakeholders in a proper manner when needed.

You may be interested in reading two works done in 2011 (http://www.ncbi.nlm.nih.gov/pubmed/22867910) and 2015 (http://www.tandfonline.com/doi/abs/10.1080/19320248.2014.962772?journalCode=when20) on this topic. I have other works compiled as I read a lot on the topic a few years ago so feel free to write me ( aurore.virayie@gmail.com) if you need further documentation.

All the best and please keep us posted

Dr Charulatha Banerjee

Asia Regional Knowledge Management Specialist

Normal user

13 Jul 2016, 08:03

Hi Eric, Is the intervention area identified to be food insecure? If yes are there other interventions to address household food insecurity not limited to Ready To Use Products for MAM children. In my understanding this would be a very important factor influencing sharing amongst children in the same household.

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