Severe Acute Malnutrition in KZN A Decade Review. Lenore Spies Director: Nutrition World Public Health Nutrition Conference August 2016

Transcription

1 Severe Acute Malnutrition in KZN A Decade Review Lenore Spies Director: Nutrition World Public Health Nutrition Conference August 2016

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3 KZN scenario KZN has the 2 nd largest population in the country of 10.6 million (19.8%) Unemployment rate at 33% compared 29.8% nationally % of households with no access to piped water. Second highest in the country. 68% use electricity for cooking. KZN bears a disproportionately high burden of poverty with 63% to 82% of households living on less than R800 per month 2 HIV incidence 39,4% 3, More than 1 million people on ART Successful PMTCT Programme - Infant 1 st PCR Test Positive around 6wks rate: 1.2% (2015/16) 1. Census District Health Barometer Antenatal Seroprevalence Survey 2013

4 KZN scenario Malnutrition remains one of the leading comorbidities for children under the age of 5 years (34%) 4 In 2015 /2016 financial year, there were approximately 4000 deaths of children under deaths (7%) had underlying severe acute malnutrition This presentation will outline how KZN has decreased SAM CFR over a 10 year period and the programmes that support this reduction. 4. Saving Children 2011

5 19 Provincial SAM Case Fatality over 10 years /2007 DHIS Data / / / / / / / / /2016 Provincial

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7 19 Provincial SAM Case Fatality over 10 years PEM Scheme IYCF Policy to stop free infant formula Integrated Management of Acute Malnutrition Community Profiling for Malnutrition 11 WHO Protocol Implementation / / / / / / / / / /2016 Provincial

8 Packages of Nutrition Interventions Lancet 2013

9 Infant Feeding Interventions MBFI (49/52 = 94%) Included in CEOs Performance Agreements 71 Active MBFI Assessors (27 in 2011 ) Human Milk Banking 6 Central and 6 Satellite HMBs Provincial Guidelines, SOPs, Reporting Tools and Training Package 331 infants received DHM from 202 donors (2015/16) Creation and Development of Human Capacity 567 Nutrition Advisors (PHC) and 59 Lactation Advisors (Maternity Facilities) Training and Mentoring on Lactation Support Skills Development and Implementation of Communication Strategy Two key Messages: EBF and BF in the context of HIV Made by Mom Campaign Radio PSAs, Video PSAs, Radio Dramas World Breastfeeding Week

10 90% 80% Infant Feeding Practices in KZN 2011/ / % 79.5% 70% 63% 69.1% 60% 57.5% 50% 40% 34% 49.1% 50.2% 41.7% 45.1% 30% 26% 20% 10% 0% 2011_ _ _ _ _16 Proportion of babies initiated and breastfed within an hour of birth Trend Infant Exclusively Breastfed at Hep B 3rd Dose Trend KIBS Baseline Survey 2015

11 Interventions to prevent malnutrition in KZN The Need to Strengthen Infant and Young Child Feeding In our analysis we noted that majority of the SAM admissions under 5 years of age, are actually under 2 years of age. Complementary feeding training package developed and implementation is ongoing In 2014 a project was implemented which provided micronutrient powders to children 6 24 months Aim improve micronutrient intake at population level for these children at the point of food intake. and to inform and educate mothers and caregivers on IYCF and introduction of complementary foods Currently upscaling

12 Vitamin A supplementation Coverage

13 Interventions to prevent malnutrition in KZN Provincial Guidelines (with National Office and WHO) On going training for health workers Pre - service training of Doctors is aligned with provincial guidelines Community mobilization for early detection of malnutrition during Child Health Week, Immunization Campaigns and Nutrition Week On going clinical audits of SAM admissions by facility, district and provincial staff. NGO support with 3 districts Provincial Government strategy to register all under 5 for early detection of malnutrition and the provision of integrated government services.

14 KZN Model Approved by SPCHD Cluster on Integrated Community Based Screening for Malnutrition

15 25 Improvements in District SAM CFR Performance SAM CFR 2015/2016 SAM CFR 2014/2015

16 40 Progress in Uthungulu and Zululand Districts following community based profiling for malnutrition Q3 Dec (2014) 2014 March Q42015 June Q Sept 2015 Q2 Dec 2015 Q3 March Q4 (2016) 2015 Zululand SAM Deaths (n) Zululand SAM CFR Uthungulu SAM Deaths (n) Uthungulu SAM CFR

17 Hospitals with highest number of SAM Deaths Stanger Lower Umfolozi Benedictine King Edward PMMH Charles Johnson Memorial DHIS Data 2016 Deaths (n) CFR (%) Hlabisa Ladysmith Murchison MGMH

18 Newcastle Niemeyer Addington King Edward RK Khan MGMH Wentworth St Marys King Dinizulu IALCH Osindisweni Prince Mshiyeni Montebello Untunjambili Umphumulo Stanger Christ the King EG Usher Memorial Rietvlei St Appolinaris GJ Crookes Murchison Port Shepstone St Andrews Appelsbosch Edendale Greys Northdale Emmaus Estcourt Ladysmith Dundee Greytown Charles Johnson Benedictine Ceza Itshelejuba Nkonjeni Vryheid Bethesda Hlabisa Manguzi Mosvold Catherine Booth Ekhombe Eshowe Lower Umfolozi Mbongolwane Nkandla KwaMagwaza Data Verification of DHIS Deaths vs Audit Report Deaths DHIS Deaths Audit Deaths DHIS Data 2016 and Audit Data

19 Capacity Building for Improved Nutrition Outcomes Provincial Nutrition Directorate District Nutrition Co-ordinators Sub District Nutritionists Hospital Based Dietitians & Rotational Community Service Dietitians Nutrition Advisors and Lactation Advisors CCG Supervisors & Community Care Givers (CCG s)

20 Mentoring & Support for Improved Nutrition Outcomes Provincial and District Office conducts monitoring and support visits to facilities Dietitian/Nutritionist support the implementation of Nutrition Services at PHC Services DHIS Data is reviewed quarterly - districts and facilities engaged on data. Information is used for decision-making. KZN has been appraised for high-level leadership, commitment and coordination as key to effective implementation of nutrition interventions, service delivery and advocacy Muller 2015 Strategies to reduce stunting in South Africa

21 A 10 year review An increase in exclusive breastfeeding rates, and Vitamin A supplementation has been accompanied by a decrease in severe acute malnutrition case fatality rate in KZN over decade. The nutrition workforce also increased substantially over the last 5 years with the inclusion of new cadres of workers (Nutrition Advisors, Lactation Advisors and sub district nutritionists).

22 1. 2 ND Commic Triennial Report Khulisa Management Services (Pty) Ltd (2014) Diagnostic / Implementation Evaluation of Nutrition Interventions for Children from Conception to Age 5. Pretoria: Department of Performance Monitoring and Evaluation. CONCLUSION The province of KZN has been successful at addressing the basic, underlying and immediate causes of malnutrition (UNICEF conceptual framework), although this is work in progress and needs to be sustained and improved to achieve zero deaths due to malnutrition. Noting the progress made particularly in areas such as the vertical transmission of HIV, decrease in malnutrition rates, and decrease in diarrheal deaths, it is evident that the despite the stressed health care system, a lot of effort is invested in improving the lives of the population as a whole and children specifically 1. KZN has been recognized by the Presidency Report (2014) as an example of success in addressing nutrition issues in South Africa 6.

23 QUESTIONS