TY - JOUR

T1 - Impact of different levels of supervision on the recovery of severely malnourished children treated by community health workers in Mali

AU - Charle-Cuéllar, Pilar

AU - López-Ejeda, Noemí

AU - Traore, Mamadou

AU - Coulibaly, Adama Balla

AU - Landouré, Aly

AU - Diawara, Fatou

AU - Bunkembo, Magloire

AU - Vargas, Antonio

AU - Gil, Ruth

AU - Briend, André

N1 - CURIS 2021 NEXS 050

PY - 2021

Y1 - 2021

N2 - Background: 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 evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods: This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. Results: A total of 6112 children aged 6-59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

AB - Background: 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 evaluates the most effective model of supervision for treating SAM using community health workers (CHWs). Methods: This study was a prospective non-randomized community intervention trial with two intervention groups and one control group with different levels of supervision. It was conducted in three districts in rural areas of the Kayes Region. In the high supervision group, CHWs received supportive supervision for the iCCM package and nutrition-specific supervision. In the light supervision group, CHWs received supportive supervision based on the iCCM package. The control group had no specific supervision. Results: A total of 6112 children aged 6-59 months with SAM without medical complications were included in the study. The proportion of cured children was 81.4% in those treated by CHWs in the high supervision group, 86.2% in the light supervision group, and 66.9% in the control group. Children treated by the CHWs who received some supervision had better outcomes than those treated by unsupervised CHWs (p < 0.001). There was no difference between areas with light and high supervision, although those with high supervision performed better in most of the tasks analyzed. Conclusions: Public policies in low-income countries should be adapted, and their model of supervision of CHWs for SAM treatment in the community should be evaluated.

KW - Faculty of Science

KW - Severe Acute Malnutrition (SAM)

KW - Community Health Workers (CHW)

KW - Integrated Community Case Management (iCCM)

KW - Supportive supervision

KW - Scaling-up interventions

U2 - 10.3390/nu13020367

DO - 10.3390/nu13020367

M3 - Journal article

C2 - 33530333

VL - 13

JO - Nutrients

JF - Nutrients

SN - 2072-6643

IS - 2

M1 - 367

ER -