Effectiveness and coverage of treatment for severe acute malnutrition delivered by community health workers in the Guidimakha region, Mauritania

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

doi:10.3390/children8121132

Effectiveness and coverage of treatment for severe acute malnutrition delivered by community health workers in the Guidimakha region, Mauritania

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

9 Citations (Scopus)

21 Downloads (Pure)

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.

Original language	English
Article number	1132
Journal	Children
Volume	8
Issue number	12
DOIs	https://doi.org/10.3390/children8121132
Publication status	Published - Dec 2021
Publication type	A1 Journal article-refereed

Funding

Funding: All the actions in the field, were supported by funds coming from U.S. Agency for International Development. Salaries of corresponding was co funded by Action against Hunger. All the actions in the field, were supported by funds coming from U.S. Agency for International Development. Salaries of corresponding was co funded by Action against Hunger. Authors would like to thank all partners who contributed to this study, Nouakchott University, Ministry of Health of Mauritania, and all the organizations of the Technical Advisory Group. Our thanks to all the mothers of the children who participated in the study for their time, to the community health workers for their work, to the community leaders and community women?s groups for their involvement, to the health personnel of the Ministry in Guidimakha Region for their support, to the entire Action Against Hunger team of Mauritania mission for their commitment with this intervention.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 2 Zero Hunger
SDG 3 Good Health and Well-being

Keywords

Community health workers (CHW)
Coverage
Integrated community case management (iCCM)
Mid-upper arm circumference (MUAC)
Severe acute malnutrition (SAM)

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

Access to Document

10.3390/children8121132Licence: CC BY

children-08-01132Final published version, 476 KBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202201101206Licence: CC BY

Cite this

@article{88ccef13b6324ec9b304dd873655b757,

title = "Effectiveness and coverage of treatment for severe acute malnutrition delivered by community health workers in the Guidimakha region, Mauritania",

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.",

keywords = "Community health workers (CHW), Coverage, Integrated community case management (iCCM), Mid-upper arm circumference (MUAC), Severe acute malnutrition (SAM)",

author = "Pilar Charle-Cu{\'e}llar and Noem{\'i} Lopez-Ejeda and Souleymane, \{Hassane Toukou\} and Diagana Yacouba and Moussa Diagana and Dougnon, \{Abdias Ogobara\} and Antonio Vargas and Andr{\'e} Briend",

note = "Funding Information: Funding: All the actions in the field, were supported by funds coming from U.S. Agency for International Development. Salaries of corresponding was co funded by Action against Hunger. Funding Information: All the actions in the field, were supported by funds coming from U.S. Agency for International Development. Salaries of corresponding was co funded by Action against Hunger. Authors would like to thank all partners who contributed to this study, Nouakchott University, Ministry of Health of Mauritania, and all the organizations of the Technical Advisory Group. Our thanks to all the mothers of the children who participated in the study for their time, to the community health workers for their work, to the community leaders and community women's groups for their involvement, to the health personnel of the Ministry in Guidimakha Region for their support, to the entire Action Against Hunger team of Mauritania mission for their commitment with this intervention. ",

year = "2021",

month = dec,

doi = "10.3390/children8121132",

language = "English",

volume = "8",

number = "12",

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T1 - Effectiveness and coverage of treatment for severe acute malnutrition delivered by community health workers in the Guidimakha region, Mauritania

AU - Charle-Cuéllar, Pilar

AU - Lopez-Ejeda, Noemí

AU - Souleymane, Hassane Toukou

AU - Yacouba, Diagana

AU - Diagana, Moussa

AU - Dougnon, Abdias Ogobara

AU - Vargas, Antonio

AU - Briend, André

N1 - Funding Information: Funding: All the actions in the field, were supported by funds coming from U.S. Agency for International Development. Salaries of corresponding was co funded by Action against Hunger. Funding Information: All the actions in the field, were supported by funds coming from U.S. Agency for International Development. Salaries of corresponding was co funded by Action against Hunger. Authors would like to thank all partners who contributed to this study, Nouakchott University, Ministry of Health of Mauritania, and all the organizations of the Technical Advisory Group. Our thanks to all the mothers of the children who participated in the study for their time, to the community health workers for their work, to the community leaders and community women's groups for their involvement, to the health personnel of the Ministry in Guidimakha Region for their support, to the entire Action Against Hunger team of Mauritania mission for their commitment with this intervention.

PY - 2021/12

Y1 - 2021/12

N2 - 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.

AB - 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.

KW - Community health workers (CHW)

KW - Coverage

KW - Integrated community case management (iCCM)

KW - Mid-upper arm circumference (MUAC)

KW - Severe acute malnutrition (SAM)

U2 - 10.3390/children8121132

DO - 10.3390/children8121132

M3 - Article

AN - SCOPUS:85121817423

SN - 2227-9067

VL - 8

JO - Children

JF - Children

IS - 12

M1 - 1132

ER -

Effectiveness and coverage of treatment for severe acute malnutrition delivered by community health workers in the Guidimakha region, Mauritania

Abstract

Funding

UN SDGs

Keywords

Publication forum classification

ASJC Scopus subject areas

Access to Document

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Cite this