Outpatient treatment of children with severe acute malnutrition within the health care system in a humanitarian crisis: a cross-sectional study in Uganda during the Horn of Africa drought response.

Abstract

Background: Uganda, situated within the Greater Horn of Africa, is currently facing a severe food insecurity crisis with the Karamoja sub-region and its neighboring districts being the most severely impacted. This sub-region exhibits the highest rate of wasting among children under the age of five, at 10%, which is significantly higher than the national average of 3.6%. This study aimed to assess the capacity of the health care system to provide quality treatment outcomes for children with severe acute malnutrition (SAM) in outpatient therapeutic care facilities.

Methods: A total of 150 health facilities across 15 districts were selected. Nutrition service delivery within the health system was assessed using an adapted Ministry of Health (MoH) Nutrition Services Delivery Assessment Tool. Key indicators-cure, death, and defaulter rates-from outpatient therapeutic care services for SAM treatment were extracted from the MoH District Health Management Information System 2 (DHIS2) for the period 2020-2023. Data analysis was conducted using SPSS.

Results: The average cure rate for children with SAM in outpatient therapeutic care was 62.3%, falling below the MoH standard of 75%. While death rates remained within the recommended threshold (< 10%), defaulter rates consistently exceeded the 15% benchmark, except in 2023. Gaps in service delivery included frequent stockouts of Ready-to-Use Therapeutic Food (RUTF) (44.9%) and the absence of outpatient therapeutic care services at designated health facilities (35.6%). Positively, 98% of health facilities had a core management team, and 81.3% had a designated nutrition focal person.

Conclusion: The quality of treatment outcomes for children admitted with severe acute malnutrition at outpatient therapeutic care facilities in this setting was below MoH standards. Strengthening supply chains and expanding services are essential to improving SAM outcomes. Despite these challenges, core management teams and designated nutrition focal persons in most facilities present an opportunity to enhance governance and integrate sustainable solutions.