Implementation of Integrated Management of Acute Malnutrition Protocol for Management of Acute Malnutrition in Piloting Sites of Wakiso District.
Introduction: Severe acute malnutrition (SAM) affects twenty million children under five years of age each year and contributes to one million child deaths per year (SCN, 2007). In Uganda, the malnutrition levels have been unacceptably high and recently the Ministry of Health developed guidelines on management of acute malnutrition. The Integrated Management of Acute Malnutrition (IMAM) protocol is supposed to be part of the routine activities within he health facilities. IMAM to be successfully implemented, a favorable environment of adequate technical human resource like the nutritionists, doctors, nurses etc. is paramount. Rolling out IMAM protocol in this country even with the low staffing levels requires to establish the current implementation status to with focus on extra load it adds to the health workers within the health facilities as well as identifying other key requirements for its success, hence the study. Study methodology: The study was a descriptive cross sectional study design and collected data using an interviewer administered questionnaire. The study population was all health workers in the health facilities that have been piloting IMAM in Wakiso district. A total number of 7 health facilities were purposively included in the study since they were implementing the IMAM protocol. A total sample of 51 health workers were reached from within all the health facilities. Key findings: Only 25% of the health workers within the facilities have been trained to implement IMAM as a new approach in the district. Despite the low training coverage, majority of the health workers (68.6%) know that weight is a nutrition assessment method and is also conduct regularly in most of the facilities. However, more than 10% of the health workers do not know how to interpret the nutrition assessment results using indices like BMI, and Z-scores. As such, the capacity of health workers is still lacking within most facilities to implement IMAM. More still, only 27.5% of the health workers are directly involved in management of acute malnutrition out of which nurses are mainly involved than any other cadre. Conclusion and recommendations: The integration of the IMAM protocol within the health facilities has not been realized. The low involvement of health workers and lack of key supplies and equipment indicates they are still implementing but not as a routine activity. The success of implementation of the IMAM protocol therefore requires building the capacity of health workers and equipping the facilities fully to ensure they are able to manage the clients. As such, the government should focus on the capacity if the health workers and infrastructure to ensure the protocol can be fully integrated.