Coverage Assessment for Community-Based Management of Acute Malnutrition in Rural and Urban Ghana: A Comparative Cross-Sectional Study

Author(s): Joana Apenkwa, Samuel Kofi Amponsah, Sam K. Newton, Reuben Osei-Antwi, Emmanuel Nakua, Anthony K. Edusei, Easmon Otupiri


Ghana for years has implemented the Community-based Management of Acute Malnutrition (CMAM) to reduce malnutrition in children. However, the prevalence of malnutrition remains high. This study aimed to determine CMAM coverage levels in the Ahafo Ano South (AAS), a rural district and Kumasi Subin sub-metropolis (KSSM), an urban district.


The study was a cross-sectional comparative study with a mixed-methods approach. In all, 497 mothers/caregivers and children under-five were surveyed using a quantitative approach while qualitative methods were used to study 25 service providers and 40 mothers/ caregivers who did not participate in the quantitative survey. Four types of coverage indicators were assessed: point coverage (defined as the number of Severe Acute Malnutrition cases [SAM] in treatment divided by total number of Severe Acute Malnutrition cases in the study district), geographical coverage (defined as total number of health facilities delivering treatment for SAM divided by total number of healthcare facilities in the study district), treatment coverage (defined as children with SAM receiving therapeutic care divided by total number of SAM children in the study district) and programme coverage (defined as number of SAM cases in the CMAM programme ÷ Number of SAM cases that should be in the programme). The qualitative approach was used to support the assessment of the coverage indicators. Data were analyzed using STATA version 14, and Atlas.ti, version 7.5 for the quantitative and qualitative data respectively.


Geographically, only 6% of the facilities in the urban communities were participating in the CMAM programme as against 29% of rural district facilities. The

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