Implementation barriers to child wasting treatment adherence: an exploratory qualitative research

Abstract

Abstract Background Child wasting remains a public health concern in low- and middle-income countries LMICs, with default rates in Lebanon exceeding 70% among children enrolled in the National Wasting Program (NWP) in 2024. This study aims to identify barriers and facilitators to treatment adherence among children aged 6–59 months in Lebanon and inform the development of a surveillance tool to identify those at high risk of defaulting. Methods An exploratory qualitative study was conducted using in-depth semi-structured interviews with key stakeholders involved in the NWP. Qualitative data were analyzed thematically using Atlas.ti to identify key themes, sub-themes, and factors influencing adherence. Results Eight key informant interviews have been conducted with representatives from international organizations supporting the NWP. Thematic analysis reveals a strong foundation with ministry engagement and coordination among actors, but the reliance on unstable external funding support makes it less sustainable. A key barrier is the absence of specific Standard Operating Procedures (SOPs) for defaulting despite the availability of updated wasting treatment guidelines. Staff workload limits engagement with caregivers and the duration of counseling, affecting adherence. At the caregiver level, barriers include financial constraints limiting the ability to afford transportation to treatment centers, as well as competing childcare responsibilities that delay consistent treatment. Recommendations emphasize strengthening follow-up communication protocols, alongside expanding community-based outreach strategies to reduce the need for caregivers to travel to treatment centers. Conclusions Multisectoral, child-centered strategies, community-based care, and updated SOPs are key to improving adherence and reducing defaulting in the treatment of child wasting in similar settings. Key messages • High default rates in child wasting treatment are linked to caregivers’ transport constraints, childcare duties, high staff workloads, and a lack of specific defaulting SOPs. • Improving adherence requires updating SOPs, strengthening follow-up communication, and expanding community-based outreach to reduce caregivers’ need to travel to centers.