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

Pilar Charle-Cuéllar,André Briend,Noemí Lopez-Ejeda,Diagana Yacouba,Antonio Vargas,Hassane Toukou Souleymane,Abdias Ogobara Dougnon,Moussa Diagana

doi:10.3390/children8121132

Abstract

Geographical and economic access barriers to health facilities (HF) have been identified as some of the most important causes of the low coverage of severe acute malnutrition (SAM) treatment. The objective of this study is to assess the effectiveness and coverage of SAM treatment delivered by community health workers (CHWs) in the Guidimakha region in Mauritania, compared to the HF based approach. This study was a nonrandomized controlled trial, including two rural areas. The control group received outpatient treatment for uncomplicated SAM from HF, whilst the intervention group received outpatient treatment for uncomplicated SAM from HF or CHWs. A total of 869 children aged 6–59 months with SAM without medical complications were included in the study. The proportion of cured children was 82.3% in the control group, and 76.4% in the intervention group, we found no significant difference between the groups. Coverage in the intervention zone increased from 53.6% to 71.7%. In contrast, coverage remained at approximately 44% in the control zone from baseline to end-line. This study is the first to demonstrate in Mauritania that the decentralization model of CHWs treating SAM improves acute malnutrition treatment coverage and complies with the international quality standards for community treatment of acute malnutrition. The non-randomized study design may limit the quality of the evidence, but these results could be used by political decision-makers as a first step in revising the protocol for acute malnutrition management.

Highlights

This article is an open access articleFood insecurity and malnutrition are often high and widespread, with seasonal peaks pushing millions into crisis in Mauritania [1]
The objective of this study is to assess the effectiveness and coverage of severe acute malnutrition (SAM) treatment delivered by community health workers (CHWs) in the Guidimakha region in Mauritania compared to the health facilities (HF) based approach
At the beginning of the study, prevalence of acute malnutrition in children under five was similar in both zones, and there was no difference between coverage of SAM treatment

Summary

Introduction

This article is an open access articleFood insecurity and malnutrition are often high and widespread, with seasonal peaks pushing millions into crisis in Mauritania [1]. In the Guidimakha region, located in the extreme south of Mauritania, the GAM prevalence in 2019 was 17%, and SAM was 2.9%, which remains a serious situation and one of the worst in the country [2]. This prevalence was higher than the emergency thresholds defined by the World Health Organization by a prevalence of GAM superior to 10% [7]. Geographical and economic access barriers to health facilities (HF) have been identified as one of the most important causes of the low coverage of malnutrition treatment [8]

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