Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger

Luis Javier Sánchez-Martínez; Pilar Charle-Cuéllar; Abdoul Aziz Gado; Abdias Ogobara Dougnon; Atté Sanoussi; Nassirou Ousmane; Ramatoulaye Hamidou Lazoumar; Fanta Toure; Antonio Vargas; Candela Lucía Hernández; Noemí López-Ejeda

doi:10.3389/fnut.2023.1253545

Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger

Front Nutr. 2023 Nov 30:10:1253545. doi: 10.3389/fnut.2023.1253545. eCollection 2023.

Affiliations

¹ Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain.
² Action Against Hunger, Madrid, Spain.
³ Action Against Hunger, Niamey, Niger.
⁴ Action Against Hunger, West and Central Africa Regional Office, Dakar, Senegal.
⁵ Nutrition Direction, Ministry of Health, Niamey, Niger.
⁶ Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger.
⁷ EPINUT Research Group (Ref. 920325), Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.

Abstract

Introduction: Of the 45.4 million children under five affected by acute malnutrition in the world, the majority (31.8 million) are affected by moderate acute malnutrition (MAM). Its treatment is particularly complex in emergency settings such as the Diffa region in Niger. This study aims to evaluate the effectiveness and coverage of a simplified treatment protocol with Community Health Workers (CHWs) as treatment providers.

Methods: This study is a non-randomized controlled trial. The control group (n = 181) received the standard protocol currently used in country, delivered by nursing staff only in health centres and health posts, while the intervention group (n = 483) received the simplified protocol which included nursing at health centres and CHWs at health post as treatment providers.

Results: The recovery rate was higher in the simplified protocol group (99.6% vs. 79.56%, p < 0.001) recording lower time to recover and higher anthropometric gain. Treatment coverage in the intervention group increased from 28.8% to 84.9% and reduced in the control group (25.3% to 13.6%). No differences were found in the recovery rate of children treated by CHWs and nursing staff.

Conclusion: The outcomes using the simplified protocol exceeded humanitarian requirements and demonstrated improvements compared to the standard protocol showing that the simplified protocol could be safely provided by CHWs in an emergency context. Further research in other contexts is needed to scale up this intervention.

Keywords: community health workers (CHWs); mid-upper arm circumference (MUAC); moderate wasting; ready-to-use therapeutic food (RUTF); simplified approaches; wasting.

Grants and funding

This research was funded by ELRHA-R2HC, Research for Health in Humanitarian Crises 6th Call2018, and BHA Bureau for Humanitarian Assistance. LS-M was granted with a predoctoral fellowship from the Complutense University and Banco Santander.