CAREGIVER AND HEALTH WORKERS' PERCEPTIONS OF READY-TO-USE-THERAPEUTIC FOOD AND LOCAL FOODS FOR SEVERE ACUTE MALNUTRITION MANAGEMENT AT A SECONDARY LEVEL HEALTH FACILITY IN NAIROBI, KENYA

Abstract

Background: Child malnutrition accounts for approximately 1 million deaths among children aged less than 5 years each year globally. World Health Organization (WHO) recommends Ready-to-Use-Therapeutic-Food (RUTF), a commercially prepared high-calorie semi-solid food, for home management of severe acute malnutrition (SAM). While studies in Kenya, Senegal, Malawi and Ethiopia have reported poor adherence and misuse of RUTF by children within community settings there is paucity of data on how caregivers view use of RUTF and the role of local foods in SAM management. In this study, we sought to understand caregivers’ experiences with RUTF and local foods for SAM management as well as health workers’ perspectives on local foods provided to children with SAM.
Methodology: In November 2019, we conducted two focus group discussions (FGDs) with caregivers of children with SAM and eleven in-depth interviews (IDIs) with healthcare workers (HCWs) at Mbagathi County Hospital (MCyH), Nairobi, based on saturation of ideas. Interviews and discussions were audio-recorded and transcribed verbatim. Thematic analysis using open coding was done to identify emerging themes.
Results: We identified the following five themes from FGDs and IDIs: 1) RUTF perceived by caregivers as beneficial in SAM management. 2) Children do not, however, adhere to RUTF prescriptions. 3) Caregivers prefer to give home foods in place of RUTF. 4) Low-nutrient home foods provided to children are associated with poor caregiver knowledge 5) Need for enhanced facility-based caregiver counselling on locally available high-nutrient foods.

Conclusion: This paper demonstrates that, despite caregivers' understanding of the importance of RUTF, locally available foods play a central role in the home management of severe malnutrition. It also highlights the importance of ensuring adequate caregiver counselling on appropriate local high-nutrient foods that they should provide to children.