1. Introduction
malaria, edema, diarrhea, malnutrition
ACUTE RESPIRATORY INFECTIONS, MALARIA, EDEMA, MEDICAL COMPLICATION, MALNUTRITION, MALNUTRITION IN CHILDREN
Background: the aim of this study is to evaluate the effectiveness and coverage of a simplified protocol that is implemented in health centers (HCs) and health posts (HPs) for children who are suffering from severe acute malnutrition (SAM) in the humanitarian context of Diffa. Methods: We conducted a non-randomized community-controlled trial. The control group received outpatient treatment for SAM, without medical complications, at HCs and HPs with the standard protocol of community management of acute malnutrition (CMAM). Meanwhile, with respect to the intervention group, the children with SAM received treatment at the HCs and HPs through a simplified protocol wherein the mid-upper arm circumference (MUAC) and the presence of edema were used as the admission criteria, and the children with SAM were administered doses of fixed ready-to-use therapeutic food (RUTF). Results: A total of 508 children, who were all under 5 years and had SAM, were admitted into the study. The cured proportion was 87.4% in the control group versus 96.6% in the intervention group (Niger is one of the countries in the Sahel region, which is recurrently confronted each year with food insecurity for a large majority of its population. In the context of complex humanitarian emergencies and challenges to the socioeconomic conditions of the population, hundreds of families are forced to move due to security problems and armed conflicts. This, coupled with periods of recurrent drought and rain, raises the rate of acute malnutrition in children under 5 years of age to a critical situation [According to Niger’s community management of acute malnutrition (CMAM) policy, treatment is separated into two distinct programs. The requirement for treatment of SAM is defined as a weight-for-height z-score (WHZ) of less than −3, per the World Health Organization (WHO) growth reference by sex and age, the presence of edema, or a mid-upper arm circumference (MUAC) of less than 115 mm. These children are treated with ready-to-use therapeutic food (RUTF) in accordance with the child’s weight as determined in a follow-up. Additionally, MAM treatment is defined as a WHZ of above −3 and below −2, or a MUAC between 115 and 125 mm, for which children receive a fixed dose of ready-to-use supplementary food (RUSF). Two different programs ensure the distribution of these two therapeutic inputs; UNICEF distributes RUTF for the treatment of children with SAM, and the World Food Programme (WFP) ensures the distribution of RUSF for children with MAM. As stated in the Ministry of Health’s National Community Health Strategy 2014–2025, the bottom level of the health pyramid is formed by health centers (HCs) and health posts (HPs) at the community level (which have to be located more than 5 km away to avoid overlap). In a HC, a nurse is normally responsible for preventive activities for children and pregnant women, as well as all curative actions, including the treatment of acute malnutrition. In a HP, there is a community health worker (CHW) who is responsible for carrying out health promotions and preventive actions, as well as curative actions for diarrhea, malaria, and acute respiratory infections—this is also known as the integrated community case management (iCCM) package of activities. This package includes SAM identification, but not its treatment (the children identified must be referred to the nearest HC for treatment) [Over the last few years, the Government of Niger has made an effort to contribute to universal health coverage (UHC) and toward the Sustainable Development Goals (SDG), such as SDG 1, aimed at no poverty; SDG 2, aimed at zero hunger; and SDG 3, aimed good health and wellbeing. For these goals, the government needs to improve the case management of acute malnutrition [Simplified approaches for acute malnutrition treatment are defined by UNICEF as a set of initiatives aimed at improving effectiveness and coverage, while maintaining the quality of care, as well as at reducing costs to families and health systems. Among these simplified approaches are decentralization through CHW-led treatment, and the use of a combined/simplified protocol [The aim of this study is to evaluate the effectiveness and coverage of the simplified ComPAS when it is applied to treat SAM at HCs and HPs in a humanitarian context in the Diffa region of Niger.