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  11. 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.
  1. Home
  3. Research Domains
  5. Health Sciences
  7. Health Services And Systems
  9. Family Care
  11. 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.

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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.

Noemí López-Ejeda1, Pilar Charle-Cuéllar2, Salimata Samake3

  • 1EPINUT Research Group (ref. 920325), Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain.

Frontiers in Public Health
|March 7, 2024

View abstract on PubMed

Summary
This summary is machine-generated.
Keywords:
childrencoveragemiddle-upper arm circumferenceready-to-use therapeutic food

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A simplified outpatient treatment program for acute malnutrition, integrating severe and moderate cases and utilizing community health workers (CHWs), significantly improved treatment coverage and reduced costs. This approach ensures better care for vulnerable children without compromising effectiveness.

Area of Science:

  • Public Health
  • Pediatrics
  • Nutrition Science

Background:

  • Outpatient treatment for acute malnutrition is often fragmented by severity, leading to access and management challenges.
  • Centralized health center-based programs complicate case detection, care delivery, and supply chains for families.
  • Decentralization and protocol simplification are potential solutions to improve malnutrition treatment accessibility.

Purpose of the Study:

  • To assess the impact of a simplified, combined treatment protocol for severe and moderate acute malnutrition.
  • To evaluate the effectiveness of decentralizing treatment delivery through community health workers (CHWs).
  • To compare a simplified protocol with standard care in terms of recovery rates, cost, and coverage.

Main Methods:

recovery
wasting
  • A three-armed cluster randomized controlled trial involving 2,038 children aged 6-59 months with non-complicated acute malnutrition in Mali.
  • Control arm: Standard treatment in health centers. Intervention arms: Standard protocol with CHWs, and a simplified ComPAS protocol with CHWs and nurses.
  • Coverage assessed using the SLEAC methodology; non-inferiority hypothesis tested.

    • Main Results:

    • Recovery rates were 76.3% (control), 81.8% (standard + CHWs), and 92.9% (simplified protocol), demonstrating non-inferiority and significant differences.
    • Therapeutic food expenditure was significantly lower with the simplified protocol (43 fewer sachets for severe cases).
    • Treatment coverage increased significantly with the simplified combined program (SAM +42.5%, MAM +13.8%), with lower discharge errors by CHWs (6% vs. 19%).

    Conclusions:

    • A simplified, combined treatment program delivered by CHWs improves coverage and reduces costs for acute malnutrition.
    • This integrated approach maintains non-inferior effectiveness and ensures better continuum of care for vulnerable children.
    • Decentralizing malnutrition treatment through CHWs with simplified protocols is a viable strategy to enhance public health outcomes.