Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes

Abstract

Severe acute malnutrition (SAM) affects over 16.6 million children worldwide. The integrated Community Case Management (iCCM) strategy seeks to improve essential health by means of nonmedical community health workers (CHWs) who treat the deadliest infectious diseases in remote rural areas where there is no nearby health center. The objective of this study was to assess whether SAM treatment delivered by CHWs close to families' locations may improve the early identification of cases compared to outpatient treatment at health facilities (HFs), with a decreased number complicated cases referred to stabilization centers, increased anthropometric measurements at admission (closer to the admission threshold) and similarity in clinical outcomes (cure, death, and default). The study included 930 children aged 6 to 59 months suffering from SAM in the Kita district of the Kayes Region in Mali; 552 children were treated by trained CHWs. Anthropometric measurements, the presence of edema, and other medical signs were recorded at admission, and the length of stay and clinical outcomes were recorded at discharge. The results showed fewer children with edema at admission in the CHW group than in the HF group (0.4% vs. 3.7%; OR = 10.585 [2.222-50.416], p = 0.003). Anthropometric measurements at admission were higher in the CHW group, with fewer children falling into the lowest quartiles of both weight-for-height z-scores (20.2% vs. 31.5%; p = 0.002) and mid-upper arm circumference (18.0% vs. 32.4%; p<0.001), than in the HF group. There was no difference in the length of stay. More children in the CHW group were cured (95.9% vs. 88.7%; RR = 3.311 [1.772-6.185]; p<0.001), and there were fewer defaulters (3.7% vs. 9.8%; RR = 3.345 [1.702-6.577]; p<0.001) than in the HF group. Regression analyses demonstrated that less severe anthropometric measurements at admission resulted in an increased probability of cure at discharge. The study results also showed that CHWs provided more integrated care, as they diagnosed and treated significantly more cases of infectious diseases than HFs (diarrhea: 36.

Effectiveness and Coverage of Treatment for Severe Acute Malnutrition Delivered by Community Health Workers in the Guidimakha Region, Mauritania

“…These results are consistent with the hypothesis of an earlier case detection resulting from the increased coverage of screening. Our results with MUAC are consistent with those found by Lopez-Ejeda et al in Mali, where children treated by CHWs in the lowest quartile were 18% vs. 32.4% at HF, and the median MUAC at admission was 115 mm compared to 114 mm at HF [30]. No difference was found in our study when considering the WHZ criteria at admission.…”

Impact of Integration of Severe Acute Malnutrition Treatment in Primary Health Care Provided by Community Health Workers in Rural Niger

“…The proportion of children within the lowest quartile was significantly smaller for both indicators (MUAC: 19.4% vs. 37.4%; WHZ: 21.1% vs. 32.6%). Similar results have been reported in Mali, where children treated by CHWs registered lower anthropometric measurements at admission and fewer edema cases than those attended at formal health facilities [26]. In the present study, the proportion of children with edema did not differ between treatment providers in the intervention group.…”

Effectiveness of screening and treatment of children with severe acute malnutrition by community health workers in Simiyu region, Tanzania: a quasi-experimental pilot study

“…Assessment of SAM treatment via CHWs was found to be cost-effective 11 . Two studies have assessed the cost‐effectiveness from the community perspective.…”

“…Studies from Africa 11 , 12 and Asia 13 show that malnourished children with no complications treated at home by CHWs have a higher cure rate and lower default rate than those treated in health facilities. There is also evidence that CHWs can deliver good quality care 14 and using them to treat SAM is cost-effective 15 .…”