2.1. Study Design and Location
death, weight loss
COMPLICATIONS, MEDICAL COMPLICATION
We conducted a non-randomized community-controlled trial involving children aged 6–59 months, who were admitted for the treatment of SAM without medical complications from December 2020 to April 2021, and who were in two health areas in the Diffa region in southeastern Niger. Children included in the study corresponded to cases that the study supervisors could transcribe from the registration sheet during their visits to each treatment site. Those children identified as having SAM with complications during the study were referred for inpatient treatment to the hospital in N’Guigmi.The control group involved children treated in the health area of Kablewa in its HC and three HPs located in the Kawa, Kortininga, and Oudi Peulh villages. In this group, the standard CMAM protocol of the country was applied. The intervention group consisted of children treated in the N’Guigmi health area in its HC and the three HPs located in the Bonégral, Birziweya, and N’Gagala villages. In both groups, other treatment outcomes were recorded: death; default, when the child was absent for two consecutive follow-up visits; non-response, when weight loss was registered or anthropometric recovery stagnated in two successive visits; and referral, when medical complications appeared that required inpatient treatment. To these criteria that are outlined in the national protocol, we added another criterion of discharge error, which was for cases classified as cured in the record sheet but whose anthropometry did not meet the requirements to be classified as cured, as described for each study group. The children were rechecked once a week until they reached one of the program’s exit criteria, i.e., a MUAC of ≥125 mm and/or a WHZ of ≥−2. According to the policy in the country, children could receive treatment for a maximum of 8 consecutive weeks. They also received amoxicillin (50–100 mg/kg/day, divided twice a day for five days) and one single dose of 500 mg of mebendazole at the first visit for deworming. Both intervention sites’ groups received monthly supervision by the Action Against Hunger team. Twice during the project, the technical committee formed by the National Directorate of Nutrition, who are responsible for the Ministry of Health at the regional level, and Action Against Hunger conducted the evaluation and monitoring of the study in the field.