Community health workers in rural Nigeria without formal medical education can successfully identify, treat and refer cases of malnutrition in children under five when using simplified tools and having received training, a study carried out by Malaria Consortium in Niger state found. The results were published in BMC Health Services Research.
Non-medical community health workers — also known as community-oriented resource persons (CORPs) in Nigeria — treat children under five for malaria, diarrhoea and pneumonia in hard-to-reach areas in their homes and diagnose and refer cases of severe illness to health facilities as part of integrated community case management (iCCM).
Although iCCM is recognised as a strategy for increasing access to life-saving treatment for childhood illnesses, severe acute malnutrition (SAM) is not currently adequately addressed in the Nigerian national iCCM guidelines. CORPs are meant to just screen for SAM and then refer to health facilities for treatment even though SAM is a major determinant of childhood mortality and morbidity.
The study investigated if, with training and supportive supervision, CORPs in Nigeria can treat SAM among under-fives and refer complicated cases using simplified protocols as part of an iCCM programme.
A series of revisions were made to make malnutrition tools more user-friendly and compliant with the cultural context of the study areas. The MUAC tool for example, a tape with different colour zones which indicate the degree of malnourishment when measuring a child’s upper arm, included an amendment of the tape colours and weighing scale to align with iCCM colour codes for danger signs and referrals alongside the use of context-specific images in the simplified protocol.
“This important study from Niger state demonstrates that community health workers already engaged in managing acute illness in children under five when adequately supplied and supervised were capable of successfully diagnosing and treating severe and moderate acute malnutrition without complications using tools and feeding protocols modified to address low literacy skills.
If expanded across countries affected by food insecurity, these findings can improve access to care for children suffering from acute malnutrition by enabling services to be delivered closer to home. This reduces out of pocket expenditure for families and the costs of delivering quality care,” said Prudence Hamade, Senior Technical Advisor at Malaria Consortium.
For the study, sixty CORPs already providing iCCM services were trained and deployed in their communities with the target of enrolling 290 SAM cases. Of the 303 children enrolled, complete records with all data elements were available for 288 children (95 percent). The study used a sequential multi-method design, conducted between July 2017 and May 2018 in Niger state and funded by Eleanor Crook Foundation (ECF).
The study’s approach was acceptable to all stakeholders, however, the effect of the extra workload of integrating SAM into iCCM on the quality of care provided by CORPs should be assessed further to better understand its sustainability and suitability in wider settings.