Abstract
BackgroundIn most health systems, Community Health Workers (CHWs) identify and screen for severe acute malnutrition (SAM) in the community. This study aimed to investigate the potential of integrating SAM identification and treatment delivered by CHWs, in order to improve the coverage of SAM treatment services.MethodsThis multicentre, randomised intervention study was conducted in Kita, Southwest Mali between February 2015 and February 2016. Treatment for uncomplicated SAM was provided in health facilities in the control area, and by Community Health Workers and health facilities in the intervention area. Clinical outcomes (cure, death and defaulter ratios), treatment coverage and quality of care were examined in both the control and intervention group.ResultsSix hundred ninety nine children were admitted to the intervention group and 235 children to the control group. The intervention group reported cure ratios of 94.2% compared to 88.6% in the control group (risk ratio 1.07 [95% CI 1.01; 1.13]). Defaulter ratios were twice as high in the control group compared to the intervention group (10.8% vs 4.5%; RR 0.42 [95% CI 0.25; 0.71]). Differences in mortality ratios were not statistically significant (0.9% in the intervention group compared to 0.8% in the control group). Coverage rates in December 2015 were 86.7% in intervention group compared to 41.6% in the control (p < 0.0001).ConclusionsWith minimal training, CHWs are able to appropriately treat SAM in the community. Allowing CHWs to treat SAM reduces defaulter ratios without compromising treatment outcomes and can lead to improved access to treatment.Trial registrationRetrospectively registered in ISRCTN Register with ISRCTN33578874 on March 7th 2018.
Highlights
In most health systems, Community Health Workers (CHWs) identify and screen for severe acute malnutrition (SAM) in the community
In total, 699 children were admitted to the intervention group and 235 children were admitted to the control group
Almost 50% of cases were admitted based on Middle Upper Arm Circumference (MUAC) and more children in intervention group reported MUAC measurements between 150 mm -115 mm at admission compared to control group (52.9% vs. 46.8%)
Summary
Community Health Workers (CHWs) identify and screen for severe acute malnutrition (SAM) in the community. This study aimed to investigate the potential of integrating SAM identification and treatment delivered by CHWs, in order to improve the coverage of SAM treatment services. The capacity to meet global SAM needs is dependent on treatment coverage being significantly improved [9] by addressing barriers to access. As a means of improving coverage of other health interventions, task shifting of services to community health workers has been explored. The iCCM package included the identification and referral of children with SAM by CHWs but does not currently include treatment of SAM at a community level [13]
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