a1 Valid International Ltd, Unit 14, Standingford House, 26 Cave Street, Oxford, OX4 3TN, UK
a2 Centre for International Child Health, Institute of Child Health, London, WC1N 1EH, UK
a3 Division of Epidemiology, Institute of Ophthalmology, University College London, London, EC1V 9EL, UK
Objective To compare therapeutic feeding programme coverage for severely malnourished children achieved by a community-based therapeutic care (CTC) programme and a therapeutic feeding centre (TFC) programme operating in neighbouring districts in Malawi.
Design Two surveys were implemented simultaneously one in each of the two programme areas. Each survey used a stratified design with strata defined using the centric systematic area sample method. Thirty 100 km2 quadrats were sampled. The community or communities located closest to the centre of each quadrat were sampled using a case-finding approach. Cases were defined as children aged under 5 years with ≤ 70% of the weight-for-height median or bilateral pitting oedema. Receipt of treatment was ascertained by the child's presence in a therapeutic feeding programme or by documentary evidence. Coverage in each quadrat was estimated in two ways, a period estimate that provides an estimation of coverage for the recent period preceding the survey and a point estimate that provides an estimation of coverage at the exact point in time of the survey.
Results Overall the period coverage was 24.55% (95% confidence interval (CI) = 17.8–31.4%) in the TFC programme and 73.64% (95% CI = 66.0–81.3%) in the CTC programme. The point coverage was 20.04% (95% CI = 13.8–26.3%) in the TFC programme and 59.95% (95% CI = 51.4–68.5%) in the CTC programme.
Conclusions In this context, CTC gave substantially higher programme coverage than a TFC programme. Given effective treatment, this enabled higher impact of CTC on severe malnutrition in this population.
(Received March 16 2006)
(Accepted November 14 2006)
(Online publication April 30 2007)