Effectiveness of Acute Malnutrition Treatment at Health Center and Community Level with a Simplified, Combined Protocol in Mali: An Observational Cohort Study

• DOI: 10.20944/preprints202209.0102.v1
• Publication Date: 2022-09-07T04:55:31Z
• Authors: Suvi T. Kangas; Bethany Marron; Zachary Tausanovitch; Elizabeth Radin; Josiane Andrianar...; Salimou Dembele; Issa Niamanto Cou...; Cesaire Ouedraogo; Marie Biotteau; Bareye Ouologuem; Soumaila Daou; Fatoumata Traore; Issiaka Traore; Marc Nene; Jeanette Bailey
• Keywords: 2. Zero hunger; Malnutrition; acute malnutrition; combined protocol; community-based management of acute malnutrition; mid-upper-arm circumference; simplified protocol; wasting; Mali; Article; 3. Good health; Cohort Studies; Observational Studies as Topic; 03 medical and health sciences; nutrition; Treatment Outcome; 0302 clinical medicine; Humans; Edema; Child

The simplified, combined protocol admits children with a mid-upper-arm circumference (MUAC) of <125 mm or edema to malnutrition treatment with ready-to-use therapeutic food (RUTF) prescribing 2 daily RUTF sachets to children with MUAC <115 mm or edema and 1 daily sachet to those with MUAC ≥115 mm but <125 mm. This treatment has previously been shown to result in non-inferior programmatic outcomes compared to standard treatment. We aimed at observing its effectiveness in a routine setting at scale, including via delivery by community health workers (CHW). A total of 27 601 children were admitted to the simplified, combined treatment. Treatment resulted in 96% overall recovery with a mean LOS of 40 days and a mean RUTF consumption of 63 sachets per child treated. Among children admitted with MUAC <115 mm or edema 94% recovered with a mean LOS of 55 days and consuming an average of 97 RUTF sachets. Recovery in all sub-groups studied exceeded 90%.Treatment by CHWs resulted in similar (96%) recovery as treatment by formal health care workers (96%). The simplified, combined protocol results in high recovery and low RUTF consumption per child treated, and can safely be adopted by CHWs to provide treatment in the community-level.