BACKGROUND and PURPOSE OF THE STUDY
Save the Children led the implementation of Feed the Future Ethiopia Growth through Nutrition, United States Agency for International Development’s (USAID’s) flagship, 2016-2023, multi-sector nutrition and Water, Sanitation and Hygiene (WASH) project, which aims to improve the nutritional status of women and young children in six, regions of Ethiopia. Since August 2022, Feed the Future Growth through Nutrition is supporting health system recovery in seventeen woredas in Amhara region. The interventions include identifying and addressing the needs of the community and the health system within its scope. To inform the ongoing efforts and to document lessons, the activity has planned to conduct a qualitative assessment on factors for discharge against medical advises in stabilization centers in Amhara region and assess efforts to address major reasons for self-discharge such as access to care-giver’s food.
Severe acute malnutrition (SAM) is a pervasive problem in Ethiopia. Complicated SAM cases are particularly at increased risk of death and need inpatient management in stabilization centers. During the last one year, more than 45,000 SAM children were discharged from inpatient care with a death rate of 1.73% and defaulter rate of 1.68%. The defaulter rate in Amhara, however, was much higher than the national average with 193 from the total 4,874 discharges (i.e. 3.96% of the discharged) were against the medical advices.
Discharge against medical advice (DAMA) refers to instances in which patients are discharged from a health care setting against the recommendation(s) of their clinician. This may be at their insistence or at the wishes of their substitute decision maker (SDM). ‘Defaulter’ is the term that is currently used to describe DAMA in the nutrition programs. Studies on DAMA in SAM inpatient care, however, are scarce in Ethiopia and across the globe. The factors and the ultimate outcomes of these vulnerable children remain largely unknown. Family and socioeconomic factors predisposing the child to this grave condition are unique, and the driving factors that force care-givers to default the inpatient care deserve careful investigation. Some strategies like ‘food-for-care takers’ and ‘providing professional education to parents and expressing the benefits and disadvantages of refusing complete treatment to help parents make better decisions are being tried in different set ups. Without proper understanding, however, setting a strategy to ensure the ultimate consideration- the best interests of the incapable child will be challenging. This study aims to fill this evidence gap.
METHOD
Qualitative study with in-depth interviews and focus group discussions (FGDs) of care-givers and service providers among purposively selected woredas and health facilities through data collection by experienced interviewers and a supervisor will be recruited by the study lead who will ensure the quality of the data collection and analysis.
ACTIVITIES, TASKS, AND DELIVERABLES
Tasks/responsibilities of the Study Lead
· Lead the study with active engagement in the design and tool development.
· Lead in-depth interviews and focus group discussions (FGDs) of care-givers and service providers
· Recruit experienced interviewers and a supervisor who will ensure the quality of the data collection and analysis.
· Work in close collaboration with the save the children technical team
· Translate Interview Guides and data collection tools to the local language (Amharic).
· Pre-test the tool. Lead and supervise data collection, translate the transcribed data to English
· Conduct analysis of data.
· Produce of preliminary and final quality report with recommendations
Deliverables
· Pre-tested study tool
· Row data (transcript and recordings)
· Draft report
· First report on January 1, 2022 and final reports on January 7, 2022
· PPT slides of findings
Detail Technical criteria by scoring point
# | Applicant | Comparing criteria score from (%) | |||
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| Criteria 1 (20%) | Criteria 2 (30%) | Criteria 3 (25%) | Criteria 4 (25%) |
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| Experience on research and academic qualification | Experience on qualitative study | Quality of submitted sample of previous research reports | Experience on nutrition and health system |
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· Scoring above 70 percent in technical criteria is the technical bench mark to pass for financial evaluation
PERIOD OF PERFORMANCE
Twenty four days level of effort between Dec 8, 2022 and January 7, 2023.
The start and end dates are subject to slight change depending on the start of the contract date.
STUDY SETUP
The study will be conducted in Amhara region, four to six health facilities in 2-4 conflict affected woredas that will be jointly selected.