Effectiveness, cost-effectiveness, and coverage of severe acute malnutrition (SAM) treatment delivered by Community Health Workers (CHWs) in Mali and Niger

What did the study set out to achieve?

Tackling acute malnutrition is a global humanitarian priority. Two studies in Mali and Niger demonstrated that decentralisation of treatment to health post level, using a simplified-combined protocol, has the potential to increase treatment coverage and decrease costs of acute malnutrition treatment in humanitarian settings.

This research project tested for the first time Community Health Worker (CHW)-led treatment using a simplified-combined protocol in humanitarian settings. A 3-arm non-inferiority RCT was conducted in Gao, Mali, and a non-randomised trial conducted in Diffa, Niger.

What were the findings?

Findings from both locations indicate the approach is effective at treating acute malnutrition, and cost-effective, lowering costs and improving coverage. The use of a simplified- combined protocol could simplify implementation, reducing errors, costs and amounts of ready to use foods (RUFs) required to treat acute malnutrition. These results are relevant for humanitarian actors and governments focused on tackling malnutrition and improved support for community health workers.

What does this mean for practitioners and policymakers?

The involvement of CHWs and decentralisation of acute malnutrition treatment to community health posts (HPs) in remote villages could increase treatment coverage in humanitarian settings while reaching Sphere Standards and maintaining quality of care.

The use of a simplified- combined protocol could simplify implementation, reducing errors, costs and amounts of RUFs required to treat acute malnutrition. Decentralisation of treatment to CHW sites is a cost-effective strategy due to lower costs and impact on treatment coverage.

Including acute malnutrition treatment into the package of activities provided at HPs allows the integration of acute malnutrition treatment with other diseases and ensure the continuum of care when extended to children with moderate acute malnutrition.