Factors Affecting Defaulting in Children's Supplemental Feeding Programs in Chad, Kenya, and Sudan Open Access

Schroeder, Megan (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/5999n430s?locale=en
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Abstract

Background. One key measure of supplemental feeding program (SFP) effectiveness is the recovery rate. Defaulting is a main factor undermining the recovery rate and very common in SFPs. However, to date, no studies have quantitatively investigated factors associated with defaulting in SFPs.

Objective. This study evaluated baseline factors associated with defaulting in children's SFPs in an urban and semi-urban community in Chad, a rural, semi-nomadic community in Kenya, and an internally displaced persons (IDP) camp in Sudan.

Methods. Data were collected from questionnaires (N = 687 (Chad), N = 297 (Kenya), N = 808 (Sudan)) administered to caregivers of children with moderate acute malnutrition (MAM) ages 6-59 months upon their admission into an SFP. The questionnaire collected information on household characteristics, SFP accessibility, opportunity costs to attend the SFP, knowledge of the SFP, and reasons for attending. Country-specific multivariate logistic regression models were built using backward elimination to evaluate factors associated with the outcome of interest, SFP defaulting.

Results. Program defaulting was common (48.5% (Chad), 25.6% (Kenya), 42.9% (Sudan)). In multivariable analyses, the primary factors (p<0.05) reducing the risk of defaulting included: children were refused admission to SFPs previously, the precipitating reason for becoming MAM was illness, keeping livestock, food insecurity, a familial support system in the same house, the caregiver's age, an IDP residency status, and trying to register a child for the SFP previously. The primary factors increasing the risk of defaulting included: higher opportunity costs and possible stigma/shame in community.

Conclusions. We found factors associated with SFP defaulting were locale-specific. Our data indicate that program implementers should address locale-specific opportunity costs, stigma/shame associated with malnutrition, and caregivers with little/no familial support systems in the same households by identifying and providing additional support to these households and implementing community level stigma reducing programs.

Table of Contents

LITERATURE REVIEW 1

Acute Malnutrition 1

Interventions Addressing Acute Malnutrition 1

Targeted Supplemental Feeding Programs 3

Efficacy of Feeding Programs 4

Defaulting 5

Defaulting Rates 6

Factors affecting Defaulting in Therapeutic Feeding Programs for SAM 6

Factors affecting Defaulting in Supplemental Feeding Programs 10

Conclusion 15

Student Contribution 18

Thesis Manuscript 18

Title Page 18

ABSTRACT 19

INTRODUCTION 21

METHODS 22

Ethics statement 22

Population and Sample 23

Data collection 25

Outcomes 26

Data Analysis 26

RESULTS 27

Significant Factors 27

Chad (Table 2). 27

Kenya (Table 3). 28

Sudan (Table 4). 28

Non-significant Factors (Data is not shown) 29

DISCUSSION 29

Significant Factors 29

Non-significant Factors 33

Limitations 34

CONCLUSIONS 34

Tables 36

Table 1. 36

Table 2. 37

Table 3. 39

Table 4. 41

Figures 45

Figure 1. 45

Conclusions and Recommendations 46

References 48

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