Scaling severe acute malnutrition treatment with community health workers: a geospatial coverage analysis in rural Mali

Abstract

Background In 2015, the Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated Community Case Management (iCCM). This paper aims to analyze the impact of including community health workers (CHWs) as treatment providers outside the Health Facilities (HFs) on the coverage of SAM treatment when scaling up the intervention in the three largest districts of the Kayes Region in Mali. Methods A baseline coverage assessment was conducted in August 2017 in the three districts before the CHWs started treating SAM. The end-line assessment was conducted one year later, in August 2018. Coverage was assessed by the standardized methodology called Semi-Quantitative Evaluation of Access and Coverage (SQUEAC). The primary outcome was treatment coverage and other variables evaluated were the geographical distribution of the HFs, CHW’s sites and overlapping between both health providers, the estimation of children with geographical access to health care and the estimation of children screened for acute malnutrition in their communities. Results Treatment coverage increased in Kayes (28.7–57.1%) and Bafoulabé (20.4–61.1%) but did not in Kita (28.4–28.5%). The decentralization of treatment has not had the same impact on coverage in all districts, with significant differences. The geospatial analyses showed that Kita had a high proportion of overlap between HFs and/or CHWs 48.7% (39.2–58.2), a high proportion of children without geographical access to health care 70.4% (70.1–70.6), and a high proportion of children not screened for SAM in their communities 52.2% (51.9–52.5). Conclusions Working with CHWs in SAM increases treatment coverage, but other critical aspects need to be considered by policymakers if this intervention model is intended to be scaled up at the country level. To improve families’ access to nutritional health care, before establishing decentralized treatment in a whole region it must be considered the geographical location of CHWs. This previous assessment will avoid overlap among health providers and ensure the coverage of all unserved areas according to their population densities need. Trial registration: ISRCTN registry with ID 1990746. https://doi.org/10.1186/ISRCTN14990746

Caregivers’ perceptions of and experiences with severe acute malnutrition among children aged 6 to 59 months in the Ari Zone, South Ethiopia: An exploratory-descriptive qualitative study.

“…Early detection of symptoms in the community can lead to complications in children. This nding is equivalent to that of a study in Mali, in which a large percentage of children lacked physical access to healthcare, and children in their neighborhoods were not screened for SAM (55). A typical SAM presentation is inversely diagnosed by the community, and traditional healers give the name 'kella', which is said to be a disease that comes genetically but has no relation to nutrition and is perceived to have no solution in modern medicine because that problem is a devastating difference from concurrent science.…”

Effectiveness of decentralizing outpatient acute malnutrition treatment with community health workers and a simplified combined protocol: a cluster randomized controlled trial in emergency settings of Mali

“…Nevertheless, the coverage figures reported in the present study were markedly lower than those reported in the aforementioned studies, with none of the groups reaching the 50% required by the SPHERE standards for acute malnutrition treatment programs in rural settings ( 31 ). A previous geospatial study conducted in another rural region of Mali ( 20 ) emphasized the importance of not only increasing the number of CHWs but also considering their location to avoid leaving high-density underserved areas and overlapping with other provision sites. This study also highlights the need to maintain malnutrition screening at the community level for the iCCM approaches to be effective for treatment coverage.…”

Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation

“…Access to treatment in the project area before the intervention was low, with coverage surveys indicating a treatment coverage of 20.4% (12.9%–30.8%) in Bafoulabé, 28.7% (20.6%–38.6%) in Kayes, and 28.4% (19.9%–39.2%) in Kita. 19 Low coverage was partly due to long distances to health facilities. In Mali, an estimated 42% of the population lives more than 5 km away from a health center.…”

“…20 A year after the integration of acute malnutrition treatment into the package of care provided by CHWs, treatment coverage increased to 61.1% in Bafoulabé and increase to 57.1% in Kayes but did not change in Kita. 19 …”

“…Data from coverage surveys conducted at the start and the end of the study period, as well as data from socioeconomic surveys, were considered in the interpretation. 19 …”