Abstract
Abstract
Background
In 2015, the Ministry of Health in Mali included the treatment of severe acute malnutrition (SAM) into the package of activities of the integrated Community Case Management (iCCM). This paper aims to analyze the impact of including community health workers (CHWs) as treatment providers outside the Health Facilities (HFs) on the coverage of SAM treatment when scaling up the intervention in the three largest districts of the Kayes Region in Mali.
Methods
A baseline coverage assessment was conducted in August 2017 in the three districts before the CHWs started treating SAM. The end-line assessment was conducted one year later, in August 2018. Coverage was assessed by the standardized methodology called Semi-Quantitative Evaluation of Access and Coverage (SQUEAC). The primary outcome was treatment coverage and other variables evaluated were the geographical distribution of the HFs, CHW’s sites and overlapping between both health providers, the estimation of children with geographical access to health care and the estimation of children screened for acute malnutrition in their communities.
Results
Treatment coverage increased in Kayes (28.7–57.1%) and Bafoulabé (20.4–61.1%) but did not in Kita (28.4–28.5%). The decentralization of treatment has not had the same impact on coverage in all districts, with significant differences. The geospatial analyses showed that Kita had a high proportion of overlap between HFs and/or CHWs 48.7% (39.2–58.2), a high proportion of children without geographical access to health care 70.4% (70.1–70.6), and a high proportion of children not screened for SAM in their communities 52.2% (51.9–52.5).
Conclusions
Working with CHWs in SAM increases treatment coverage, but other critical aspects need to be considered by policymakers if this intervention model is intended to be scaled up at the country level. To improve families’ access to nutritional health care, before establishing decentralized treatment in a whole region it must be considered the geographical location of CHWs. This previous assessment will avoid overlap among health providers and ensure the coverage of all unserved areas according to their population densities need.
Trial registration: ISRCTN registry with ID 1990746. https://doi.org/10.1186/ISRCTN14990746
Funder
Innocent Foundation
The European Civil Protection and Humanitarian Aid Oprations
Post Code Lottery Foundation
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,Public Administration
Reference38 articles.
1. UNICEF. Levels and trends in child malnutrition: UNICEF/WHO/The World Bank Group joint child malnutrition estimates: key findings of the 2021 edition.2021. https://www.who.int/publications-detail-redirect/9789240025257. Accessed 9 Feb 2022.
2. Myatt M, Khara T, Dolan C, Garenne M, Briend A. Improving screening for malnourished children at high risk of death: a study of children aged 6–59 months in rural Senegal. Public Health Nutr. 2019;22(5):862–71. https://doi.org/10.1017/S136898001800318X.
3. OCHA. Global Humanitarian Overview 2021. https://reliefweb.int/report/world/global-humanitarian-overview-2021-enarfres. Accessed 23 Apr 2021.
4. OMS, UNICEF. Enquête Nationale Nutritionnelle Anthropométrique et de Mortalité rétrospective suivant la méthodologie SMART, Mali 2018. https://www.unicef.org/mali/media/2326/file/SMART%202018.pdf . Accessed 23 Apr 2021.
5. De Onis M, Borghi E, Arimond M, Webb P, Croft T, Saha K, et al. Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public Health Nutr. 2019;22(1):175–9. https://doi.org/10.1017/S1368980018002434.
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