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

Calistus Wilunda,Bupe Abel Ntoga,Vincenza Lorusso,Giulia Segafredo,Gloria Maya,Donata Dalla Riva,Giovanni Putoto,Chacha Magige,Fabio Manenti,Germana Leyna,Fortihappiness Gabinus Mumba,Elias Musa

doi:10.1038/s41598-021-81811-6

Abstract

Health system constraints hamper treatment of children with severe acute malnutrition (SAM) in Tanzania. This non-inferiority quasi-experimental study in Bariadi (intervention) and Maswa (control) districts assessed the effectiveness, coverage, and cost-effectiveness of SAM treatment by community health workers (CHWs) compared with outpatient therapeutic care (OTC). We included 154 and 210 children aged 6–59 months with SAM [mid-upper arm circumference (MUAC) < 11.5 cm] without medical complications in the control and intervention districts, respectively. The primary treatment outcome was cure (MUAC ≥ 12.5 cm). We performed costing analysis from the provider’s perspective. The probability of cure was higher in the intervention group (90.5%) than in the control group (75.3%); risk ratio (RR) 1.17; 95% CI 1.05, 1.31 and risk difference (RD) 0.13; 95% CI 0.04, 0.23. SAM treatment coverage was higher in the intervention area (80.9%) than in the control area (41.7%). The cost per child treated was US$146.50 in the intervention group and US$161.62 in the control group and that per child cured was US$161.77 and US$215.49 in the intervention and control groups, respectively. The additional costs per an additional child treated and cured were US$134.40 and US$130.92, respectively. Compared with OTC, treatment of children with uncomplicated SAM by CHWs was effective, increased treatment coverage and was cost-effective.

Highlights

Health system constraints hamper treatment of children with severe acute malnutrition (SAM) in Tanzania
This study showed that using community health workers (CHWs) to treat children with uncomplicated SAM was superior compared to the standard outpatient therapeutic care (OTC) model
A recent review that included 12 peer-reviewed articles and 6 grey literature from Africa and Asia on management of uncomplicated SAM by CHWs showed that CHWs could identify and treat uncomplicated cases of SAM, achieving cure rates above the minimum standards and reducing default r ates[20]

Summary

Introduction

Health system constraints hamper treatment of children with severe acute malnutrition (SAM) in Tanzania. This non-inferiority quasi-experimental study in Bariadi (intervention) and Maswa (control) districts assessed the effectiveness, coverage, and cost-effectiveness of SAM treatment by community health workers (CHWs) compared with outpatient therapeutic care (OTC). In the last two decades, the model to address treatment of SAM shifted from centralized small-scale inpatient treatment to the establishment of decentralized outpatient therapeutic feeding programs through the implementation of the Community Management of Acute Malnutrition (CMAM)[5]. To health facilities for assessment by professional health workers, and outpatient or inpatient treatment of the undernourished children This strategy was designed to improve treatment outcomes and coverage through early detection and early treatment initiation of malnourished children. The result is a low coverage of SAM services, a high relapse rate, and a high case fatality rate that is above the acceptable range of 5–10% 10

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Conclusion