ABSTRACT
This study investigated the challenges and motivation in accessing
CMAM, the challenges CMAM workers face in implementing CMAM in the rural
communities, the level of community involvement in CMAM, as well as CMAM
beneficiaries‟ perspective on how access to CMAM can be improved. 3 CMAM
centres formed part of the study. Mothers and Community Health Volunteers
(CHVs) at the various centres were selected by convenience. Consequently,
spouses (fathers) of these mothers formed part of the study. The assemblymen
for the communities in which the centres are situated, and the CMAM
implementers at the selected centres also formed part of the study. The study
employed in-depth interviews and used semi-structured interviews to obtain
qualitative data from the study participants. Questionnaires were used to
obtain quantitative data on beneficiaries‟ demographics. Descriptive statistics
such as frequencies and percentages were used to analyze demographic
characteristics of beneficiaries and the results presented in tables, while the
spider gram framework and thematic analysis was used to analyze the level of
community participation. Through a process of reading and familiarization with
the data, data collected was grouped into codes, basic themes and global
themes. Challenges and motivation in accessing CMAM, challenges in CMAM implementation,
as well as beneficiaries‟ perspective of how to improve access to CMAM were
analyzed based on these themes. Results from the study showed that majority
83.6% of the beneficiaries had no basic education, agriculture was the dominant
occupation, and 21.8% of the beneficiaries did not have a source of income. The
study also revealed that the level of involvement of beneficiaries in designing
and implementing CMAM was very low (had a score of 1 in all the spider gram
indicators). For mothers, challenges in accessing CMAM included geographic
accessibility, delay at the CMAM centre, social events, cultural/social
barriers and as well as no money for transportation and food when there is a
delay at the centre. Challenges to implementation of CMAM in the district
included poor logistics in the form of shortages of plumpy nut, problem
transporting plumpy nut to the various CMAM centres, few teaching and learning
materials for educating mothers, illiteracy/ poor enlightenment of the
community, no incentives for Community Health Volunteers (CHVs), and ridiculing
of CHVs by the communities. Lastly, gaining a source of income, receiving money
from the government, provision of accessible drinking water, increasing
rationing quantity, constant reminders from husbands and household members to
attend CMAM and help with means of transport were the various ways
beneficiaries thought access to CMAM can be improved. The study recommends
improving community involvement in CMAM through involving traditional, religious,
and opinion leaders as well as other interest groups in the decision making
activities of CMAM. Decentralization is recommended to provide CMAM in more
communities, good drinking water should be provided by the government for the
communities in the district, Ghana health Service should create a
well-structured delivery system for the CMAM programme and CHVs should be
motivated with incentives such as means of transport/transport allowances.
TABLE OF CONTENTS
ABSTRACT
TABLE OF CONTENTS
LIST OF TABLES
LIST OF FIGURES
LIST OF ABBREVIATIONS
CHAPTER ONE
INTRODUCTION
1.1 Background
1.2 Problem Statement
1.3 Research Questions
1.4 Main Research Objective
1.4.1 Specific Research
Objectives
1.5 Justification
CHAPTER TWO
LITERATURE REVIEW
2.1 Conceptual Framework of
the Study
2.2 Malnutrition Effects:
Globally and Locally
2.3 Health Inequalities
2.4 Community-based
Management of Acute Malnutrition
2.4.1 Components of CMAM
2.4.1.1 Community Outreach
2.4.1.2 Outpatient Care for
Children 6-59 Months
2.4.1.3 Inpatient Care for
Children 0-59 Months
2.4.1.4 Supplementary Feeding
of Children 6-59 Months
2.5 Access to Healthcare
Programmes
2.6 Challenges in Accessing
Rural Healthcare Programmes
2.6.1 Geographical
Accessibility to Healthcare Programmes
2.6.2 Availability of
Healthcare Programmes
2.6.3 Affordability of
Healthcare Programmes
2.6.4 Acceptability of
Healthcare Programmes
2.7 Community Participation
in Health Programmes
2.7.1 Challenges in Defining
Community Participation
2.7.2 Process Indicators of
the Spider-Gram Framework
CHAPTER THREE
STUDY AREA AND METHODOLOGY
3.1 Study Design
3.2 Description of the Study
Area
3.3 Study Population/ Target
Groups
3.4 Sampling Technique
3.5 Data Collection
3.6 Data Analysis
CHAPTER FOUR
RESULTS AND DISCUSSION
4.1 Characteristics of
Beneficiaries (Mothers and Fathers) of CMAM
4.1.1 Age Distribution of
Respondents
4.1.2 Educational Level of
Respondents
4.1.3 Source of Respondents‟
Income
4.1.4 Number of Respondents‟
Children Under Five Years
4.2 Level of Respondents‟
Participation in CMAM
4.3 Beneficiaries‟ Challenges
to Accessibility and
Motivation to Access CMAM Centre
4.3.1 Mothers‟ Challenges in
Accessing CMAM
4.3.2 Mothers‟ Motivation to
Access CMAM
4.3.3 Fathers‟ Challenges in
Aiding Spouses Access the CMAM Centre
4.3.4 Fathers‟ Motivation to
Aid Spouses Access the CMAM Centre
4.4 Challenges to
Implementation
4.5 Beneficiaries‟
Suggestions for Improving Access to CMAM
CHAPTER FIVE
CONCLUSIONS AND
RECOMMENDATIONS
5.1 Introduction
5.2 Summary and Conclusions
5.3 Recommendations
REFERENCES
APPENDICES
CHAPTER ONE
INTRODUCTION
1.1 Background
The term malnutrition generally
refers both to under-nutrition and over-nutrition, where under-nutrition means
a deficiency of one or more essential nutrients and over-nutrition means
excessive intake of food nutrients, especially in unbalanced proportions.
Malnutrition is as a result of many factors, most of which relate to poor diet
or severe and repeated infections, particularly in children and underprivileged
populations (Blossner et al., 2005). Worldwide, ten and a half million
children of age under-five die of malnutrition every year, with 98% of these
deaths reported to occur in developing countries (UNICEF, 2007). Malnutrition
is a major public health and development concern especially in sub-Saharan
Africa, and has foregoing health and socioeconomic impacts on development. The
prevalence of malnutrition among the group of under-five is rated at 40% in sub
Saharan Africa (UNICEF, 2012). United Nations (2000) identified sub-Saharan
Africa as the only region in the world where the number of child deaths is
increasing as a result of malnutrition.
Programmes such as the
Millennium Development Goals (MDGs) adopted under-fives' nutritional status as
indicators for evaluating progress. This shows the measure of importance attached
to child nutrition (UN Millennium Project, 2006). Increased morbidity and
mortality, very slow mental development, poor school performance and reduced
intellectual achievement are some of the repercussions that children who are
malnourished tend to experience (Pelletier and Frongillo, 1995). Significant
functional impairment in adult life, reduced work capacity, and consequently
poor economic productivity are some of the negative factors
associated with malnutrition especially in the early stages of childhood
(Delpeuch et al., 2000).
The three main forms of
malnutrition identified in Ghana by Ghana Health Service (2007) are Protein Energy
Malnutrition (PEM), Mineral Deficiency Malnutrition (MDM) or a combination of
both. It has the characteristics of stunting (chronic under nutrition),
underweight (acute under-nutrition) and wasting (weight loss). Insufficient
food intake and infirmities are the basic causes of malnutrition. Political,
economic, socio-cultural, physical environment, household food insecurity,
public health problems and social care of the environment are other underlying
factors that contribute to malnutrition of children under-five (Muhammed and
Naleena, 2012).
Over the past ten years, there
has been a universal initiative to move from facility-based treatment
approaches to malnutrition, to a decentralized community based approach. This
move is founded on proof that substantial limitations on coverage and access to
treatment of Severe Acute Malnutrition (SAM) cases were compounded by
limitations to health facilities. For large numbers of children with SAM to be
well treated and catered for in their communities instead of being admitted to
therapeutic feeding centres, the Community-based Management of Acute
Malnutrition (CMAM) initiative was approved (Tekeste et al., 2013). By
providing treatment at many decentralized sites instead of a few centrally
located inpatient facilities, CMAM aims to reach the maximum number of children
with acute malnutrition thereby ensuring more coverage and access to nutrition
healthcare (Ghana Health Service, 2010).
In 2007, WHO and UNICEF
introduced the community based management of acute malnutrition (CMAM)
programme in a bid to manage cases of severe malnutrition recorded at the
community level (WHO/WFP/UNICEF/UNSCN, 2007). Evolving from the Community-based
therapeutic care (CTC), CMAM consists of four main parts which are: outpatient
care for the management of SAM without medical complications, inpatient care
for the management of SAM with medical complications, management of moderate
acute malnutrition (MAM) and community outreach (Ghana Health Service, 2010).
The success of health
programmes depends very much on the extent to which the community participates,
particularly with regard to needs assessment, leadership, resource
mobilisation, management and organisation (Rifkin et al., 1988). A primary
health care intervention like CMAM would tremendously be effective if there are
high levels of participation from the community in decision making and
implementing the health programme. Therefore, knowing the extent of community
participation in CMAM, and constraints to the community‟s access to the
programme is very useful to health planners or health managers.
1.2
Problem Statement
The importance of good
nutrition cannot be over-emphasized; especially so in young children
(under-five years). Good nutrition ensures the proper growth of children and
reduces their susceptibility to infections and illnesses. Proper organ
formation and function, a strong immune system, and neurological and cognitive
development of children are all very dependent on good nutrition (Black et al.,
2008). Over the years, management of SAM has been undertaken in inpatient
facilities in hospitals and Nutrition Rehabilitation Centres (NRCs) attached to
health facilities (Ghana Health Service, 2010). It is against this background
that the Ghana Health Service (GHS) adopted the CMAM approaches to facilitate
the management of SAM beyond inpatient care. The approach is rooted in the
public health principles of expanded coverage and access, timeliness and
appropriate care (Ghana Health Service, 2010).
CMAM was introduced to the
northern parts of Ghana in 2010 and still works towards the improvement of
nutrition in children under 5 years. Despite the efforts of CMAM in battling
malnutrition for six years now by improving access and coverage to treatment,
malnutrition still rises steadily. There is a trend of continued high
prevalence of severe stunting, wasting, and under-weight forms of malnutrition
in the Northern Region (Ghana Statistical Service, 2004; WFP and VAM Food
Security Analysis, 2012; GSS et al., 2015).
The poor performance of CMAM in the Northern Region may be
due to constraints within the programme in terms of poor planning, insufficient
funds and poor implementation, amongst others. It may also be due to barriers
the community or beneficiaries face in accessing the programme, such as the
affordability of the programme, and the level of community involvement in the
programme amongst others. Therefore, the study seeks to assess the reasons
behind the poor performance of CMAM in curbing the prevalence of malnutrition
in the district.
As a result of malnutrition,
these children have weaker immune systems and are thus more susceptible to
infections and illnesses, especially malaria (UNICEF, 2013b). The educational
attainment of these children is also appreciably jeopardized. Child stunting
impacts brain development and impair motor skills. These effects in terms of
delayed motor and cognitive development are largely irreversible. Stunted
children also become less educated adults, thus making malnutrition a long-term
and intergenerational problem (Galler and Barret, 2001; UNICEF, 2006).
Neglecting the issue of malnutrition is tantamount to
disregarding the vicious cycle of poor health, lower learning capacity,
decreased physical activity and lower work performance or productivity that is
locked in malnutrition. This cycle not only threatens health and survival,
but also has the capacity to erode the foundation of economic growth, people‟s
strength and energy, and adversely tamper with initiative, creative and
analytical capacity (Horton et al., 2009). The study therefore seeks to assess
the challenges to accessing and implementing CMAM in the Tolon District.
1.3
Research Questions
The
aforementioned raise the following questions:
1.
What is the level of community
participation in CMAM in the Tolon District?
2.
What are the challenges to accessing
CMAM in the Tolon District?
3.
What are the challenges to
implementing CMAM in the Tolon district?
4.
How do beneficiaries think their
access to CMAM can be improved?
1.4
Main Research Objective
·
To investigate the level of
participation, and assess the challenges to access and implementation of CMAM
in the Tolon District.
1.4.1
Specific Research Objectives
1.
To investigate the level of
community participation in CMAM in the Tolon District
2.
To assess the challenges to
accessing CMAM in the Tolon District
3.
To assess the challenges to
implementation of CMAM in the Tolon District
4.
To investigate beneficiaries‟
perspective on how access to CMAM can be improved
1.5
Justification
According to Black et al.,
(2008), malnutrition is a serious problem because it causes the deaths of 3.5
million children under 5 years old per year in the world. Malnutrition is
responsible for majority of child deaths in the world, especially so in sub-Saharan
Africa (SSA). In early childhood, sufficient and nutritious food intake is
vital to ensure a strong immune system, healthy growth, neurological and
cognitive development, and proper organ formation and function. To think
critically, learn new skills and contribute to their communities, a
well-nourished population is needed. A well-nourished population also ensures
economic growth and human development. Child malnutrition contributes to
poverty through impeding individuals‟ ability to lead productive lives and also
impairs cognitive development and function (Black et al., 2008).
CMAM is a new intervention
which aids in controlling and curing malnutrition and which is being scaled up
by organizations such as UNICEF, WHO, and the Ghana Health Service. It is
necessary to carry out this study to understand the reasons behind the poor
performance of CMAM in eradicating malnutrition in the District. It will also
inform government, policy makers and necessary organizations on the challenges
to accessibility and implementation of CMAM in the District, as well as what
can be done to improve involvement in the upscale of CMAM. This will aid in
management and policy making decisions in effective battling of malnutrition in
the Tolon District.
For more Agricultural Economics & Extension Projects Click here
================================================================Item Type: Ghanaian Topic | Size: 90 pages | Chapters: 1-5
Format: MS Word | Delivery: Within 30Mins.
================================================================
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.