Related Experiment Video
Updated: Jun 11, 2026
Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy
Published on: August 9, 2024
Integrated community case management plus compared with outpatient therapeutic programs: a quasi-experimental study
Iris Bollemeijer1, Jennifer Majer2, Naomi Mwikali Ndung'u3
1International Medical Corps, Los Angeles, CA, United States; Wageningen University and Research, Division of Human Nutrition and Health, Wageningen, The Netherlands.
Background:
WHO guidelines endorse treatment of severe acute malnutrition (SAM) by community health workers as an alternative to facility-based care, but supportive evidence for this shift is low.
Objectives:
Among Somali children with uncomplicated SAM, we compared recovery between facility-based outpatient therapeutic programs (OTP) and integrated community case management (iCCM+), examining weight change, length of stay, discharge anthropometry, and overall anthropometric change.
Methods:
In a quasi-experimental study (3 January-19 May, 2024), children with uncomplicated SAM [weight-for-height Z-scores (WHZ) < -3 SD and/or mid-upper arm circumference (MUAC) ≤115 mm] were enrolled for treatment in OTP (2 sites, 638 children) or iCCM+ (8 villages, 545 children). During weekly follow-up visits, children received nutritional assessments, ready-to-use therapeutic food, and routine medications until discharge (MUAC >115mm; WHZ > -3SD). Weight change and time-to-recovery were analyzed using generalized linear mixed-effects models and Cox proportional hazards models, respectively. To adjust for baseline differences in observed covariates, we used propensity score adjustment.
Results:
At enrolment, OTP children had more severe anthropometric deficits than their peers in the iCCM+ group (WHZ<-3SD: 48% compared with 42%, P = 0.04; MUAC ≤110 mm: 34% compared with 18%, P < 0.001). Recovery proportions were similar between groups (iCCM+: 89%; OTP: 91%). In adjusted analyses, no difference was observed in weight change over time. The iCCM+ group had a shorter median length of stay (by 7 d) and faster time-to-recovery (adjusted hazard ratio: 3.32, 95% CI: 2.70, 4.09).
Conclusions:
Treatment outcomes were similar between approaches; iCCM+ enabled earlier identification and shorter length of stays, suggesting improved efficacy and reduced burden on caregivers and health systems. It shows promise for expanding SAM treatment in settings with limited OTP access.
Related Concept Videos
01:30Community Based Intervention
Foundations of Community Mental Health Programs
Central to the success of community-based interventions is the...
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic illness...
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:20Integrated Healthcare System
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:22Case Studies