Community-Based Management of Acute Malnutrition Programme: Rural and Urban Maternal Socio-Demographic and Implementation Differentials in Ghana
Author(s): Joana Apenkwa, Samuel Kofi Amponsah, Anthony Edusei, Emmanuel Nakua, Sam Newton, Easmon Otupiri, Chukwuma Chinaza Adaobi
Malnutrition is a public health problem in Ghana, and is estimated to contribute indirectly to more than half of under-five deaths. This study was designed to describe how implementation of the Community-based Management of Malnutrition (CMAM) programme in Ghana differs in the rural and urban parts of the country. A mixed methods approach was used in a community-based survey that studied 497 mothers/caregivers and under-five pairs quantitatively, 25 health service providers qualitatively, and 25 mothers/caregivers qualitatively. Quantitative data were analysed descriptively with Stata 14.0 (Stata Corp, Texas, USA) while the qualitative data were analysed thematically with Atlas.ti, version 7.5 (Scientific Software Development GmbH, Berlin). Programme implementation was assessed using the following variables: availability of CMAM tools, availability of CMAM supplies, organization of out-patient therapeutic and supplementary feeding programmes, personnel availability, availability of community-based components of CMAM and maternal experience with CMAM services. While the number of children alive, provision of nutrition education and counselling, and demonstration of food preparation significantly influenced program effectiveness (p<0.05) in the urban site, no variables were found to do similar in the rural district. The rural facilities were more likely than the urban ones to be without tools. Less than 10% of mothers/caregivers in both study sites acknowledged the availability of the community-based components of CMAM. Programme implementation in the two study districts is poor; in order to ensure that the CMAM intervention translates into a reduced malnutrition burden among children under-five in Ghana, the programme implementation should be revised to address the identified shortcomings.