Reasons for dropouts in a community-based Management Acute Malnutrition (CMAM) program using local foods in the Far North of Cameroon

Résumé

Introduction: The security crisis caused by the Islamic sect Boko Haram, coupled with
arid climatic conditions and a context of poverty, has preyed on populations in the far
north of Cameroon, exacerbating malnutrition rates among children under five years old.
New evidence has shown that many children with moderate acute malnutrition (MAM)
can be treated in their communities (CMAM) without having to be admitted to a health
center or therapeutic feeding center. The purpose of our study was to identify factors that
may lead to beneficiary dropout in a CMAM program in four health districts in the far
north of Cameroon.
Methods: A retrospective descriptive study of children who exited the CMAM program as
lost to follow-up. Trained CHWs interviewed mothers in the households of children
identified as lost to follow-up in the CMAM program using a questionnaire. The data
were analyzed using STATA software. The confidence interval used was 95% and a P-
value of 5%.
Results: Seven hundred and ten children were identified as being lost to the CMAM
program, 686 of whom were present in the households during the interviews. Boys were
40.20%; girls 59.79% and the median age was 19 months. In the post-CMAM period,
boys (OR=0.64; p=0.018); children in Moulvoudaye health district (OR=0.32; p=0.0025),
and households with ≥10 people were at lower risk of MAM. The risk of being MAM was
higher in households located 6-10 km and ≥10km from a health facility (OR=4.21,
p<0.0001). Vitamin A Supplementation (OR=0.37; p=0.0131) and dietary diversity
(OR=0.60; p=0.0773) protected children from MAM. The main reasons for dropping out
of the CMAM program cited by parents were that health personnel and CHWs had
declared and discharged the child as cured (44.4%); mothers received information that the project was over (17.54%); and mothers had traveled (10.2%). Other reasons: parents
not keeping appointments (4.5%); children not responding to treatment (4.8%); shortage
of food supplies (3.1%); and the long distance between the distribution site and the
household (5.6%) etc.
Conclusion: Several children were discharged as dropouts while they were still active.
These included discharge errors and those due to the end of the project. Distance, stock
shortages, failure to keep appointments, parental relocation, and illnesses in children
were all reasons for the high dropout rate. We recommend strengthening the quality of
training for health personnel and CHWs on the CMAM protocol before implementation.

Mots-clés

Community Management Acute Malnutrition, Dropout, Malnutrition, Food voucher, Lost to follow, Nutrition

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