Principal Investigators: Noemi Lopez-Ejeda, ACF and Saul Guerrero, Independent ( co-PI)
The study in Mali and Senegal will investigate a modified protocol for treatment of severe acute malnutrition delivered by Community Health Workers (CHWs) and compare it to the current Community Management of Acute malnutrition (CMAM) protocol. The approach has significant potential to increase coverage and cure rates in remote contexts with limited accessibility to health facilities. The results of our intervention could contribute to reduce costs and time of mothers and communities to treat children with severe acute malnutrition.
Severe acute malnutrition remains a major public health problem that still affects 16.6 million children under 5 years of age in the world. The development of Ready-to-Use Therapeutic Foods in the 2000s was a revolution that brought treatment closer to families. Unfortunately, with the current model of outpatient treatment at health centers, only 40% of the children who need it are being reached
The inclusion of Community Health Workers in the treatment of severe acute malnutrition with a new protocol based on simplified approaches could be that new revolution we are looking for. It could bring the treatment even closer by eliminating the main access barriers by reducing time and costs for families and this could help detect cases in less severe conditions. It would also allow a more integrated treatment with other infectious diseases that can also enhance the recovery making the intervention more cost-effective
Research findings could contribute to a significant improvement in coverage and cost saving in crisis-affected areas where access to health services is a major issue.
Effectiveness of a new intervention model with CHWs
Contribution to the continuity of care
Cost-effectiveness of the intervention
A cluster Randomised Control Trial (cRCT) with three arms in each country.
We will consider two independent variables: treatment provider (HC/HC+CHWs) and protocol applied in the case of CHWs areas (CMAM/Modified). The main dependent variables to compare within SAM children will be the rates of: recovery (discharge as cured), default (children absent two consecutive visits), unresponsiveness (children not improving nutritional status in two consecutive visits), transfer (to inpatient treatment) and death. Other variables will be severity, prevalence of non-severe complications, length of stay and average daily weight and MUAC gain.
A coverage assessment and a cost effectiveness analysis will be developed to complete the study.
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