Predictors of the amount of intake of Ready-To-Use-Therapeutic foods among children in outpatient therapeutic programs in Nairobi, Kenya

Food Science and Nutrition, Volume 10, No. 4, Year 2022

Interpretation

Ready-to-use Therapeutic Food (RUTF) therapy is a standard protocol for treating children with severe acute malnutrition (SAM) admitted in Out-Patient Therapeutic Programmes (OTP). The amount of RUTF to be consumed by a child is based on weight (200 kcal/kg body weight/day) as stipulated in the Kenya Integrated Management of Acute Malnutrition (IMAM) protocol for timely weight gain. There is limited information on the determinants of consumption of the correct amount of RUTF. This study sought to fill this gap by establishing the associations between the caregivers’ and the child’s characteristics and the amount of RUTF the child ate within a 24-h recall period. We used a cross-sectional study design and interviewed 200 caregivers of children 6–23 months of age admitted in four OTP centers in Nairobi Kenya. We used a researcher-administered questionnaire to collect information from the caregivers. Seventy-three percent of the children ate the recommended amount of RUTF. A smaller proportion (54.4%) of younger children (6–11 months of age) ate the recommended amount of RUTF compared to older children (12–17 months old and 18–23 months old at 89.1% and 82.8%, respectively). The predictors of consumption of the correct amount of RUTF were child’s birth order—firstborn (AOR 29.92; 95% CI: 5.67–157.93) and children’s age; 12–17 months old (AOR 5.19; 95% CI: 2.18–12.36) and 18–23 months (AOR 6.19 95% CI: 2.62), indicating that firstborn and older children were more likely to consume the correct amounts of RUTF. Caregivers’ knowledge and correct practices in feeding a child with RUTF also predicted the consumption of the correct amount of RUTF. In conclusion, maternal and child characteristics are determinants of the consumption of the correct amount of RUTF by children in OTP. We used a cross‐sectional analytical design with quantitative approaches to data collection, analysis, and presentation. This design enabled the studying of multiple outcome and exposure variables in a representative sample, at one point in time (Sedgwick, 2014). The dependent variable was adequate intake of RUTF. The independent variables were caregivers’ socioeconomic characteristics, such as occupation and education level and demographic characteristics, such as caregiver’s marital status, age, and parity, demographic characteristics of the child (age, sex, and birth order), and caregivers’ knowledge and practices for feeding a child with SAM. The study was conducted in four Out‐Patient Therapeutic Programme sites in Kamukunji Sub‐County, Nairobi City County: Bahati, Majengo, Eastleigh, and Biafra health centers. Each of these centers had nutritionists, nurses, and other cadres of health workers. The health facilities had operational OTP centers, integrated with the child welfare clinics within the same facility. Nutrition services offered in the OTP are integrated within the mother and child health program with strong linkage with the outpatient pediatric treatment unit, in keeping with the Kenya Integrated Management of Acute Malnutrition (IMAM) guidelines (Ministry of Medical Services & Ministry of Public Health and Sanitation, 2009; Wambani, 2012). The selected health facilities where this study was conducted are all public health facilities that get technical support from Concern Worldwide, an International Non‐Governmental Organization working in partnership with the Ministry of Health. The NGO provided support in the form of capacity building, commodity supply for the RUTF, whereas the government provided support in the form of supply of essential drugs and support supervision. The support provided by the government and the NGO ensures that the capacity of OTP staff and the community health volunteers are built and that essential nutrition commodities and treatment drugs are consistently available to provide effective and timely service delivery in the management of children with severe acute malnutrition. The caregivers do not pay for this service. In this study, we targeted caregivers with children aged 6–23 months admitted into the OTP centers in Kamukunji sub‐county, for the treatment of severe acute malnutrition. The four study locations have one thing in common, in that the majority of beneficiaries to which they provide essential health services are communities residing in Nairobi’s informal settlements. These include: Kiambiu, Biafra, City Carton, Bahati, and Pumwani‐Majengo informal settlements. Lack of access to safe, adequate and running water, inadequate sanitation facilities, inconsistent electricity supply, use of unsafe cooking fuel (paraffin, charcoal, and firewood), insufficient education support, access challenges to appropriate health and nutrition services, lack of enough space for shelter, and insufficient finances are the most common challenges in these settlements (Kimani‐Murage et al., 2011; Otieno, 2014). Most of the caregivers are involved in casual labor, petty trading, small‐scale manufacturing (Jua Kali), and illicit activities, for example, brewing unhygienic liquor. About half (51%) of residents in these informal settlements live in overcrowded conditions (Otieno, 2014). There is a widespread inappropriate infant and young child feeding (IYCF) and high rates of food security in the informal settlements (Ireri et al., 2020; Kimani‐Murage et al., 2011; Macharia et al., 2018; Simiyu et al., 2019), thus children are more likely to be exposed to suboptimal breastfeeding and complementary feeding practices which are major determinants of acute malnutrition. We purposively sampled the four OTP centers (Biafra, Majengo, Eastleigh, and Bahati) because it was necessary to target specifically the caregivers with children admitted to OTP with severe acute malnutrition, and it is these centers that have OTP services. We also considered homogeneity in living conditions (urban informal settlements) for the purposive sampling as all the four health facilities are situated in a strategic location where they serve the majority of families residing in the urban informal settlements. We recruited all the 200 caregivers and their children 6–23 months of age in the four OTP centers who were enrolled into the program at the time of the study and who met the inclusion criteria, upon obtaining their voluntary, informed consent (Martinez‐Mesa et al., 2016). Caregivers with children 6–23 months of age admitted to outpatient therapeutic program in the four specified health facilities in Kamukunji Sub‐county, presenting with severe acute malnutrition (SAM) without complications, having passed the appetite test. Children with edema grade 1 (+) without any medical complications were included in the study. In all cases, voluntary informed consent was obtained from the caregiver. We had planned that should any child sampled for the study develop medical complications (heart disease, Spina Bifida, vomiting, and presence of grade 2 or grade 3 nutritional edema [++, +++]) during the time of the study and be referred to the stabilization/inpatient center before the caregiver was interviewed, the same would be excluded from the sample. However, there were no such cases and therefore we retained the 200 sample of caregivers and their children aged 6–23 months old. Data collection was conducted by three research assistants with a Diploma level of qualification in Nutrition under the supervision of the researchers. The research assistants were trained by the researchers before data collection. The caregivers were interviewed face to face, using a researcher‐administered questionnaire. The questionnaire was content‐validated and pre‐tested with about 10 mothers who were not included in the main study. During this pre‐test, the test–retest method was used to ensure reliability, by conducting two interviews 7 days apart (Batterham, 2011; Kothari & Garg, 2014). The questionnaire yielded a correlation coefficient of 0.7 using the Cronbach’s Correlation formula, which is acceptable (Kothari & Garg, 2014). Some adjustments were made to the questionnaire after pre‐test. The questionnaire had questions on caregiver’s knowledge and practices, such as breastfeeding and the amount of RUTF the child ate in the last 24 h, giving water to the child to drink, safe storage of RUTF, washing hands before feeding the child, and not giving any other complementary food when the child was on RUTF therapy. The interviews were conducted at the OTPs on the days the caregivers and their children had scheduled weekly clinic appointments at the health facilities. The questions assessing the feeding practices among the caregivers were based on the Kenya Ministry of Health Integrated Management of Acute Malnutrition (IMAM) protocols (Ministry of Medical Services & Ministry of Public Health and Sanitation, 2009) for feeding a child with severe acute malnutrition, which are based on the WHO guidelines. These guidelines stipulate that children admitted to OTP should be on RUTF therapy and are only permitted to breastfeed, according to IMAM protocols (Ministry of Medical Services & Ministry of Public Health and Sanitation, 2009). Adequate intake of RUTF for children with SAM was determined by calculating the proportion of children 6–23 months of age, who consumed 200 kcal of RUTF per kilogram of body weight the day before the survey. The assessment considered the content of the RUTF given to the children with SAM as an exclusive meal because it contains all the required energy and micronutrients to meet the nutritional needs of children with severe acute malnutrition. Each sachet of RUTF supplies 500 kcal (Ministry of Medical Services & Ministry of Public Health and Sanitation, 2009); hence, the daily rations based on the weight of the child are further calculated in terms of the number of sachets, for the sake of easy understanding and administration by the caregiver. Adequate dietary intake, therefore, refers to the consumption of an adequate amount of RUTF by the child with SAM, according to IMAM protocol. During the interview, the weight of the child was taken from what was recorded in the OTP ration card during the last appointment and recorded by the researcher, and the mother was asked to state the amount of RUTF (in form of sachets) the child ate on the day prior to the survey. The information on the weight and the number of RUFT sachets consumed was recorded in the researcher‐administered questionnaire, and from this an appropriate response was recorded as to whether the child consumed adequate amount of RUTF or not. Data analysis was conducted using the SPSS software (version 22). Descriptive statistics (frequencies, means, medians, standard deviations, and percentages) were used to describe the caregivers and child demographic characteristics and maternal knowledge and practices on feeding a child with SAM. The Caregivers’ knowledge on feeding a child with SAM was based on eight knowledge items out of which the mean knowledge score was calculated. One point was awarded for each correct answers resulting in a total score of 8, whereas zero was awarded for incorrect answers, and thus the least score was zero. Chi‐square test was used to establish associations between categorical variables. Multiple logistic regression was performed to establish the determinants of consumption of the correct amount of RUTF in the last 24 h among the children with SAM. A p‐value of <.05 was used as a criterion for statistical significance.

AI Digest

Study Justification:

This study aimed to investigate the factors influencing the consumption of the correct amount of Ready-To-Use Therapeutic Food (RUTF) among children with severe acute malnutrition (SAM) in outpatient therapeutic programs (OTP) in Nairobi, Kenya. The study was conducted due to the limited information available on the determinants of RUTF consumption, which is crucial for the effective treatment of SAM. By identifying the predictors of RUTF intake, this study provides valuable insights for improving the management of SAM in OTPs.

Highlights:

– 73% of the children consumed the recommended amount of RUTF.
– Younger children (6-11 months) had a lower proportion (54.4%) of consuming the recommended amount compared to older children (12-17 months: 89.1%, 18-23 months: 82.8%).
– The predictors of consuming the correct amount of RUTF were the child’s birth order (firstborn) and age (12-17 months and 18-23 months).
– Caregivers’ knowledge and correct practices in feeding a child with RUTF also influenced the consumption of the correct amount.

Recommendations:

1. Improve caregiver education and awareness: Provide targeted education programs to caregivers on the importance of consuming the correct amount of RUTF and proper feeding practices for children with SAM.
2. Enhance caregiver support: Offer counseling and support services to caregivers to address any challenges they may face in feeding their children with RUTF.
3. Strengthen monitoring and supervision: Implement regular monitoring and supervision of OTP centers to ensure adherence to feeding protocols and provide necessary guidance to caregivers.
4. Tailor interventions for younger children: Develop specific interventions to address the lower consumption of RUTF among younger children, considering their unique needs and challenges.

Key Role Players:

1. Nutritionists: Provide expertise and guidance on proper feeding practices and RUTF consumption.
2. Nurses: Support the implementation of feeding protocols and provide counseling to caregivers.
3. Health Workers: Assist in monitoring and supervision of OTP centers and provide support to caregivers.
4. Community Health Volunteers: Play a role in educating and supporting caregivers in the community.

Cost Items for Planning Recommendations:

1. Training and Capacity Building: Budget for training programs for nutritionists, nurses, and health workers to enhance their knowledge and skills in managing SAM and supporting caregivers.
2. Educational Materials: Allocate funds for the development and distribution of educational materials for caregivers, including brochures, posters, and audiovisual resources.
3. Counseling Services: Include resources for providing counseling services to caregivers, either through hiring additional staff or partnering with existing counseling organizations.
4. Monitoring and Supervision: Allocate funds for regular monitoring and supervision visits to OTP centers to ensure adherence to protocols and provide necessary support.
5. Community Outreach: Set aside a budget for community outreach activities, such as awareness campaigns and training sessions conducted by community health volunteers.
Please note that the cost items provided are general suggestions and may vary based on the specific context and resources available.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional study design with a representative sample, which is a strength. The study collected data using a researcher-administered questionnaire and conducted statistical analysis. However, the study design limits the ability to establish causality, and there may be potential confounding factors that were not accounted for. To improve the evidence, a longitudinal study design could be considered to establish temporal relationships and control for confounding variables. Additionally, including a control group of children not receiving RUTF therapy could provide further insights into the determinants of RUTF consumption.

Abstract

We used a cross‐sectional analytical design with quantitative approaches to data collection, analysis, and presentation. This design enabled the studying of multiple outcome and exposure variables in a representative sample, at one point in time (Sedgwick, 2014). The dependent variable was adequate intake of RUTF. The independent variables were caregivers’ socioeconomic characteristics, such as occupation and education level and demographic characteristics, such as caregiver’s marital status, age, and parity, demographic characteristics of the child (age, sex, and birth order), and caregivers’ knowledge and practices for feeding a child with SAM. The study was conducted in four Out‐Patient Therapeutic Programme sites in Kamukunji Sub‐County, Nairobi City County: Bahati, Majengo, Eastleigh, and Biafra health centers. Each of these centers had nutritionists, nurses, and other cadres of health workers. The health facilities had operational OTP centers, integrated with the child welfare clinics within the same facility. Nutrition services offered in the OTP are integrated within the mother and child health program with strong linkage with the outpatient pediatric treatment unit, in keeping with the Kenya Integrated Management of Acute Malnutrition (IMAM) guidelines (Ministry of Medical Services & Ministry of Public Health and Sanitation, 2009; Wambani, 2012). The selected health facilities where this study was conducted are all public health facilities that get technical support from Concern Worldwide, an International Non‐Governmental Organization working in partnership with the Ministry of Health. The NGO provided support in the form of capacity building, commodity supply for the RUTF, whereas the government provided support in the form of supply of essential drugs and support supervision. The support provided by the government and the NGO ensures that the capacity of OTP staff and the community health volunteers are built and that essential nutrition commodities and treatment drugs are consistently available to provide effective and timely service delivery in the management of children with severe acute malnutrition. The caregivers do not pay for this service. In this study, we targeted caregivers with children aged 6–23 months admitted into the OTP centers in Kamukunji sub‐county, for the treatment of severe acute malnutrition. The four study locations have one thing in common, in that the majority of beneficiaries to which they provide essential health services are communities residing in Nairobi’s informal settlements. These include: Kiambiu, Biafra, City Carton, Bahati, and Pumwani‐Majengo informal settlements. Lack of access to safe, adequate and running water, inadequate sanitation facilities, inconsistent electricity supply, use of unsafe cooking fuel (paraffin, charcoal, and firewood), insufficient education support, access challenges to appropriate health and nutrition services, lack of enough space for shelter, and insufficient finances are the most common challenges in these settlements (Kimani‐Murage et al., 2011; Otieno, 2014). Most of the caregivers are involved in casual labor, petty trading, small‐scale manufacturing (Jua Kali), and illicit activities, for example, brewing unhygienic liquor. About half (51%) of residents in these informal settlements live in overcrowded conditions (Otieno, 2014). There is a widespread inappropriate infant and young child feeding (IYCF) and high rates of food security in the informal settlements (Ireri et al., 2020; Kimani‐Murage et al., 2011; Macharia et al., 2018; Simiyu et al., 2019), thus children are more likely to be exposed to suboptimal breastfeeding and complementary feeding practices which are major determinants of acute malnutrition. We purposively sampled the four OTP centers (Biafra, Majengo, Eastleigh, and Bahati) because it was necessary to target specifically the caregivers with children admitted to OTP with severe acute malnutrition, and it is these centers that have OTP services. We also considered homogeneity in living conditions (urban informal settlements) for the purposive sampling as all the four health facilities are situated in a strategic location where they serve the majority of families residing in the urban informal settlements. We recruited all the 200 caregivers and their children 6–23 months of age in the four OTP centers who were enrolled into the program at the time of the study and who met the inclusion criteria, upon obtaining their voluntary, informed consent (Martinez‐Mesa et al., 2016). Caregivers with children 6–23 months of age admitted to outpatient therapeutic program in the four specified health facilities in Kamukunji Sub‐county, presenting with severe acute malnutrition (SAM) without complications, having passed the appetite test. Children with edema grade 1 (+) without any medical complications were included in the study. In all cases, voluntary informed consent was obtained from the caregiver. We had planned that should any child sampled for the study develop medical complications (heart disease, Spina Bifida, vomiting, and presence of grade 2 or grade 3 nutritional edema [++, +++]) during the time of the study and be referred to the stabilization/inpatient center before the caregiver was interviewed, the same would be excluded from the sample. However, there were no such cases and therefore we retained the 200 sample of caregivers and their children aged 6–23 months old. Data collection was conducted by three research assistants with a Diploma level of qualification in Nutrition under the supervision of the researchers. The research assistants were trained by the researchers before data collection. The caregivers were interviewed face to face, using a researcher‐administered questionnaire. The questionnaire was content‐validated and pre‐tested with about 10 mothers who were not included in the main study. During this pre‐test, the test–retest method was used to ensure reliability, by conducting two interviews 7 days apart (Batterham, 2011; Kothari & Garg, 2014). The questionnaire yielded a correlation coefficient of 0.7 using the Cronbach’s Correlation formula, which is acceptable (Kothari & Garg, 2014). Some adjustments were made to the questionnaire after pre‐test. The questionnaire had questions on caregiver’s knowledge and practices, such as breastfeeding and the amount of RUTF the child ate in the last 24 h, giving water to the child to drink, safe storage of RUTF, washing hands before feeding the child, and not giving any other complementary food when the child was on RUTF therapy. The interviews were conducted at the OTPs on the days the caregivers and their children had scheduled weekly clinic appointments at the health facilities. The questions assessing the feeding practices among the caregivers were based on the Kenya Ministry of Health Integrated Management of Acute Malnutrition (IMAM) protocols (Ministry of Medical Services & Ministry of Public Health and Sanitation, 2009) for feeding a child with severe acute malnutrition, which are based on the WHO guidelines. These guidelines stipulate that children admitted to OTP should be on RUTF therapy and are only permitted to breastfeed, according to IMAM protocols (Ministry of Medical Services & Ministry of Public Health and Sanitation, 2009). Adequate intake of RUTF for children with SAM was determined by calculating the proportion of children 6–23 months of age, who consumed 200 kcal of RUTF per kilogram of body weight the day before the survey. The assessment considered the content of the RUTF given to the children with SAM as an exclusive meal because it contains all the required energy and micronutrients to meet the nutritional needs of children with severe acute malnutrition. Each sachet of RUTF supplies 500 kcal (Ministry of Medical Services & Ministry of Public Health and Sanitation, 2009); hence, the daily rations based on the weight of the child are further calculated in terms of the number of sachets, for the sake of easy understanding and administration by the caregiver. Adequate dietary intake, therefore, refers to the consumption of an adequate amount of RUTF by the child with SAM, according to IMAM protocol. During the interview, the weight of the child was taken from what was recorded in the OTP ration card during the last appointment and recorded by the researcher, and the mother was asked to state the amount of RUTF (in form of sachets) the child ate on the day prior to the survey. The information on the weight and the number of RUFT sachets consumed was recorded in the researcher‐administered questionnaire, and from this an appropriate response was recorded as to whether the child consumed adequate amount of RUTF or not. Data analysis was conducted using the SPSS software (version 22). Descriptive statistics (frequencies, means, medians, standard deviations, and percentages) were used to describe the caregivers and child demographic characteristics and maternal knowledge and practices on feeding a child with SAM. The Caregivers’ knowledge on feeding a child with SAM was based on eight knowledge items out of which the mean knowledge score was calculated. One point was awarded for each correct answers resulting in a total score of 8, whereas zero was awarded for incorrect answers, and thus the least score was zero. Chi‐square test was used to establish associations between categorical variables. Multiple logistic regression was performed to establish the determinants of consumption of the correct amount of RUTF in the last 24 h among the children with SAM. A p‐value of <.05 was used as a criterion for statistical significance.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop mobile applications that provide information and reminders to caregivers about the correct amount of RUTF to be consumed by their children. These apps can also provide educational resources on maternal and child health.

2. Community Health Workers: Train and deploy community health workers to provide education and support to caregivers in the community. These workers can visit households, conduct home visits, and provide personalized guidance on feeding practices and the correct amount of RUTF.

3. Telemedicine: Implement telemedicine services to allow caregivers to consult with healthcare professionals remotely. This can help address any concerns or questions about feeding practices and ensure that caregivers have access to expert advice.

4. Behavior Change Communication: Develop targeted behavior change communication campaigns to raise awareness and educate caregivers about the importance of consuming the correct amount of RUTF. This can be done through various channels such as radio, television, and community meetings.

5. Supply Chain Management: Improve the supply chain management of RUTF to ensure consistent availability in health facilities. This can involve streamlining procurement processes, optimizing storage and distribution, and monitoring stock levels to prevent stockouts.

6. Peer Support Groups: Establish peer support groups where caregivers can share their experiences, challenges, and best practices related to feeding their children with RUTF. These groups can provide emotional support, practical tips, and a sense of community.

7. Incentives and Rewards: Introduce incentive programs to motivate caregivers to adhere to the recommended amount of RUTF. This can include rewards such as vouchers, discounts, or small gifts for caregivers who consistently follow the guidelines.

8. Continuous Training and Education: Provide ongoing training and education for healthcare professionals, community health workers, and caregivers on the latest guidelines and best practices for feeding children with SAM. This can help ensure that everyone involved has up-to-date knowledge and skills.

9. Integration of Services: Integrate maternal health services with existing nutrition programs and child welfare clinics. This can facilitate comprehensive care and ensure that caregivers receive information and support on both maternal and child health.

10. Data Monitoring and Evaluation: Implement a robust data monitoring and evaluation system to track the consumption of the correct amount of RUTF and identify areas for improvement. This can help identify trends, measure the impact of interventions, and inform future strategies.

It’s important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the target population.

AI Innovations Description

Based on the description provided, the study aimed to identify predictors of the amount of intake of Ready-To-Use Therapeutic Foods (RUTF) among children in outpatient therapeutic programs in Nairobi, Kenya. The study found that 73% of the children consumed the recommended amount of RUTF. The predictors of consuming the correct amount of RUTF were the child’s birth order (firstborn) and age (12-17 months and 18-23 months). Caregivers’ knowledge and practices in feeding a child with RUTF also influenced the consumption of the correct amount of RUTF.

To develop this recommendation into an innovation to improve access to maternal health, the following steps can be taken:

1. Education and Awareness: Develop educational materials and conduct awareness campaigns targeting caregivers and communities to increase knowledge about the importance of RUTF and proper feeding practices for children with severe acute malnutrition. This can be done through community health workers, health facilities, and other relevant stakeholders.

2. Training and Capacity Building: Provide training and capacity building programs for healthcare providers, including nutritionists, nurses, and community health workers, on the correct administration and monitoring of RUTF therapy. This will ensure that healthcare providers have the necessary skills and knowledge to support caregivers in feeding their children with the correct amount of RUTF.

3. Integration of Services: Integrate RUTF therapy and maternal health services within the existing healthcare system to improve access and coordination of care. This can be done by incorporating RUTF therapy into routine antenatal and postnatal care visits, as well as child welfare clinics. This will ensure that pregnant women and new mothers receive information and support regarding proper nutrition for themselves and their children.

4. Community Engagement: Engage the community in the design and implementation of programs to improve access to maternal health. This can be done through community meetings, focus group discussions, and involvement of community leaders and influencers. By involving the community, the programs can be tailored to the specific needs and challenges faced by the community, leading to better acceptance and uptake of services.

5. Monitoring and Evaluation: Establish a system for monitoring and evaluating the implementation and impact of the innovation. This will help identify areas of improvement and ensure that the desired outcomes are being achieved. Regular feedback from caregivers and healthcare providers can also be used to make necessary adjustments and improvements to the innovation.

By implementing these recommendations, access to maternal health can be improved, leading to better health outcomes for both mothers and children.

AI Innovations Methodology

To improve access to maternal health, here are some potential recommendations:

1. Mobile health clinics: Implementing mobile health clinics that travel to remote or underserved areas can provide essential maternal health services, including prenatal care, vaccinations, and postnatal check-ups. This can help reach women who have limited access to healthcare facilities.

2. Telemedicine: Utilizing telemedicine technology can enable pregnant women to receive virtual consultations and medical advice from healthcare professionals. This can be particularly beneficial for women in rural areas who may have difficulty traveling to healthcare facilities.

3. Community health workers: Training and deploying community health workers who are knowledgeable about maternal health can help educate and support pregnant women in their communities. These workers can provide information on prenatal care, nutrition, and safe delivery practices, as well as assist in identifying high-risk pregnancies.

4. Maternal health vouchers: Implementing voucher programs that provide financial assistance for maternal health services can help reduce the financial barriers that prevent women from accessing necessary care. These vouchers can cover services such as prenatal visits, delivery, and postnatal care.

5. Transportation support: Providing transportation support, such as subsidized or free transportation services, can help pregnant women overcome geographical barriers and reach healthcare facilities for prenatal care and delivery.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population that will be affected by the recommendations, such as pregnant women in a particular region or community.

2. Collect baseline data: Gather data on the current access to maternal health services in the target population, including factors such as distance to healthcare facilities, utilization rates, and health outcomes.

3. Model the interventions: Use a simulation model to estimate the potential impact of each recommendation on access to maternal health. This can involve creating a mathematical model that incorporates factors such as population size, geographical distribution, and healthcare infrastructure.

4. Input data and assumptions: Input relevant data and assumptions into the simulation model, such as the number of mobile health clinics, the coverage area, the number of telemedicine consultations, or the number of community health workers deployed.

5. Run simulations: Run multiple simulations using different scenarios and parameters to estimate the potential impact of the recommendations on access to maternal health. This can help identify the most effective interventions and their potential outcomes.

6. Analyze results: Analyze the simulation results to determine the projected changes in access to maternal health services, such as increased utilization rates, reduced travel distances, or improved health outcomes.

7. Validate and refine the model: Validate the simulation model by comparing the projected results with real-world data, if available. Refine the model based on feedback and additional data to improve its accuracy.

8. Communicate findings: Present the findings of the simulation study to relevant stakeholders, such as policymakers, healthcare providers, and community organizations. This can help inform decision-making and resource allocation for implementing the recommended interventions.

It’s important to note that the methodology for simulating the impact of recommendations may vary depending on the specific context and available data.

Author

Dima Health

Identifiers:

DOI: 10.1002/fsn3.2745

Research Areas:

Community Interventions, Environmental, Food Security, Health System and Policy, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Social Determinants

Study Countries:

Kenya

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative