The effectiveness of treatment for Severe Acute Malnutrition (SAM) delivered by community health workers compared to a traditional facility based model

Morán, Jose Luis Alvarez; Alé, G. B. Franck; Charle, Pilar; Sessions, Natalie; Doumbia, S.; Guerrero, Saúl

doi:10.1186/s12913-018-2987-z

Cited by 31 publications

(33 citation statements)

References 13 publications

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“…In the other area, the iCCM+ protocol was applied; in addition to HFs, treatment by CHWs close to the households was added (intervention group: 3 HFs + 17 CHWs). The results of the coverage and effectiveness of this combined outpatient treatment model with medical staff at HFs plus CHWs at the household level have been previously published elsewhere [16]. According to Malian protocols, CHWs previously received two weeks of training from health staff on iCCM and CMAM techniques, with one month of on-site practice at the HF.…”

Section: Methodsmentioning

confidence: 99%

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

López‐Ejeda

Charle-Cuéllar²,

Alé

et al. 2020

PLoS ONE

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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.

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Section: Methodsmentioning

confidence: 99%

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

López‐Ejeda

Charle-Cuéllar²,

Alé

et al. 2020

PLoS ONE

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“…After a year, the coverage of SAM treatment achieved in the intervention group (treatment delivered at the health facilities with CHWs) was 86.7% compared with 43.9% in the control group during the same period ( P < 0.001). These results show that when CHWs offer SAM treatment, more children access health services (Álvarez‐Morán, Alé, Charle, et al, ). In Angola, coverage was estimated to be 82.1% in those areas where CHWs were active.…”

Section: Resultsmentioning

confidence: 72%

“…The cure rate achieved in the control group (children treated at health facilities without any CHW delivering treatment) was 88.6%. In comparison, the probability of being cured in the intervention model was higher after adjusting for sex, oedema, and MUAC at admission (risk ratio: 1.89; 95% confidence interval [1.09, 3.27], P = 0.022; Álvarez‐Morán Alé, Charle, et al, ). The projects in Angola, Malawi, and Bangladesh also achieved cure rates above 90% of children enrolled.…”

Section: Resultsmentioning

confidence: 94%

“…The lowest default rate was reported in Malawi where only 3.6% children defaulted from the programme (Amthor et al, ). In Mali, default rates were twice as high in the facility‐only control group (10.8%) compared with facility and CHWs intervention group (4.5%; risk ratio: 0.43, 95% confidence interval [0.24, 0.77], P = 0.005; Álvarez‐Morán, Alé, Charle, et al, ). Researchers linked improved access to treatment to the proximity of CHWs.…”

Section: Resultsmentioning

confidence: 98%

“…In Mali, there were more children with oedema at admission in the OTP control group (4.7%) than in the group with OTP plus CHWs (0.7%). Moreover, children in the intervention group were also twice less likely to need to be referred to stabilization centres within 24 hr of admission (Álvarez‐Morán, Alé, Charle, et al, ).…”

Section: Resultsmentioning

confidence: 99%

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Can community health workers manage uncomplicated severe acute malnutrition? A review of operational experiences in delivering severe acute malnutrition treatment through community health platforms

López‐Ejeda¹,

Charle-Cuéllar

Vargas³

et al. 2018

Maternal & Child Nutrition

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Community health workers (CHWs) play an important role in the detection and referral of children with severe acute malnutrition (SAM) in many countries. However, distance to health facilities remains a significant obstacle for caregivers to attend treatment services, resulting in SAM treatment coverage rates below 40% in most areas of intervention. The inclusion of SAM treatment into the current curative tasks of CHWs has been proposed as an approach to increase coverage. A literature review of operational experiences was conducted to identify opportunities and challenges associated with this model. A total of 18 studies providing evidence on coverage, clinical outcomes, quality of care, and/or cost‐effectiveness were identified. The studies demonstrate that CHWs can identify and treat uncomplicated cases of SAM, achieving cure rates above the minimum standards and reducing default rates to less than 8%. Although the evidence is limited, these findings suggest that early detection and treatment in the community can increase coverage of SAM in a cost‐effective manner. Adequate training and close supervision were found to be essential to ensure high‐quality performance of CHWs. Motivation through financial compensation and other incentives, which improve their social recognition, was also found to be an important factor contributing to high‐quality performance. Another common challenge affecting performance is insufficient stock of key commodities (i.e., ready‐to‐use therapeutic food). The review of the evidence ultimately demonstrates that the successful delivery of SAM treatment via CHWs will require adaptations in nutrition and health policy and practice.

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Integrated community case management of childhood illness in low- and middle-income countries

Oliphant

Manda

Daniels

et al. 2021

Cochrane Database of Systematic Reviews

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The effectiveness of treatment for Severe Acute Malnutrition (SAM) delivered by community health workers compared to a traditional facility based model

Cited by 31 publications

References 13 publications

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

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

Can community health workers manage uncomplicated severe acute malnutrition? A review of operational experiences in delivering severe acute malnutrition treatment through community health platforms

Integrated community case management of childhood illness in low- and middle-income countries

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