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Nigeria: Non-medical health workers use simplified tools to treat malnutrition in children under five in rural Nigeria

Community health workers in rural Nigeria without formal medical training can successfully identify, treat and refer cases of malnutrition in children under five using simplified tools and having received training, study finds conducted by Malaria Consortium in the State of Niger. The results were published in BMC Health Services Research.

Non-medical community health workers – also known as community-based resource persons (CORP) in Nigeria – treat children under five for malaria, diarrhea and pneumonia in hard-to-reach areas. their homes and diagnose and refer cases of serious illness to health facilities as part of integrated community case management (iCCM).

Although iCCM is recognized as a strategy to increase access to life-saving treatments for childhood illnesses, severe acute malnutrition (SAM) is currently not adequately addressed in Nigerian national iCCM guidelines. CORPs are only intended to screen for SAM and then refer to health facilities for treatment, even though SAM is a major determinant of infant mortality and morbidity.

The study examined whether, with training and supportive supervision, CORPs in Nigeria can treat SAM in children under five and refer complicated cases using simplified protocols as part of an iCCM program.

A series of revisions were made to make the malnutrition tools more user-friendly and consistent with the cultural context of the study areas. The MUAC tool, for example, a tape with different colored areas that indicate the degree of malnutrition when measuring a child’s upper arm, included a change in the colors of the tape and scale to align with iCCM color codes for danger signs and references alongside the use of context images in the simplified protocol.

“This important study from Niger State demonstrates that community health workers already engaged in the management of acute illness in children under five when properly supplied and supervised were able to diagnose and treat successfully. uncomplicated severe and moderate acute malnutrition using modified feeding tools and protocols to address poor literary skills.

If extended to food-insecure countries, these findings can improve access to care for acutely malnourished children by allowing services to be provided closer to home. This reduces the direct expenses of families and the costs of providing quality care, ”said Prudence Hamade, senior technical advisor at the Malaria Consortium.

For the study, sixty CORPs already providing iCCM services were trained and deployed in their communities with the goal of enrolling 290 SAM cases. Of the 303 children enrolled, complete records with all data elements were available for 288 children (95%). The study used a multi-method sequential design, conducted between July 2017 and May 2018 in Niger State and funded by the Eleanor Crook Foundation (ECF).

The study approach was acceptable to all stakeholders, however, the effect of the additional workload of integrating SAM into iCCM on the quality of care provided by CORPs should be further evaluated. to better understand its sustainability and suitability in broader contexts.

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