Community management of acute malnutrition (CMAM) programme in Pakistan effectively treats children with uncomplicated severe wasting.

Severe wasting is the most widespread form of severe acute malnutrition, affecting an estimated 17 million children globally. This analysis assesses the effectiveness of Pakistan's community management of acute malnutrition (CMAM) programme. We conducted a retrospective case series analysis of 32,458 children aged 6-59 months who were admitted to the programme with a mid-upper arm circumference (MUAC) < 115 mm (January 1-December 31, 2014). We found that at admission, 59.6% of the children were girls and 87.4% were in the age group 6-23 months old. While in the programme, 120 children (0.4%) died, 3,456 (10.6%) defaulted, and 28,882 (89.0%) were discharged after a mean length of stay of 69.3 ± 25.7 days. Children's mean weight gain while in the programme was 3.2 ± 2.7 g/kg body weight/day. At discharge, 28,499 children (98.7% of discharged) had recovered (MUAC ≥ 125 mm). The odds of death were significantly higher among children with weight-for-height (WHZ) < -3 and/or height-for-age (HAZ) < -2 at admission. The odds of recovery on the basis of MUAC ≥125 mm were higher among children with HAZ ≥ -2 at admission. The odds of recovery on the basis of WHZ ≥ -2 were significantly higher among children with WHZ ≥ -3 and/or HAZ < -2 at admission. Pakistan's CMAM programme is effective in achieving good survival and recovery rates. Population-level impact could be increased by giving priority to children 6-23 months old and children with multiple anthropometric failure and by scaling up CMAM in the provinces and areas where the risk, prevalence, and/or burden of severe acute malnutrition is highest.

Is Expanded Programme on Immunization doing enough? Viewpoint of health workers and managers in Sindh, Pakistan.

OBJECTIVE: To understand health managers' and service providers' views about routine immunization; perceived barriers and practical measures to improve the situation in three districts of rural Sindh and one town of Karachi, Pakistan. METHODOLOGY: Key informants interviews and focused group discussions were carried out involving district and town health officers, health providers, vaccinators, lady health visitors and lady health workers. RESULTS: The study result showed that the problems hampering the routine immunization related mainly to lack of incentives and restricted mobility of health workers in the field. Political interference, flaws in monitoring of routine immunization, disinterest of facility based doctors and lack of private sector involvement in the provision of vaccine are other major problems. National immunization days (NIDs) so far had a negative impact on routine immunization coverage. CONCLUSION: There is need of policy shift to integrate routine immunization with NIDs for polio which will help in improving routine immunization along with eradication of Polio. More incentives and clear service structure for vaccinators will raise the motivation among the EPI staff. The budgetary constraints must be overcome by involving all stakeholders both foreign and local. Public and private sector must work hand in hand to achieve the goal. Lastly, political will and support is mandatory to sustain the efforts of EPI.