C-Project Phase 1

C-Project Phase 1: pilot to generate evidence

Phase 1: Mali

From 2014 to 2016, a pilot study was developed in the Kayes Region, Kita district, at 9 health facilities with 18 Community Health Workers (CHWs).

The objective was to test an innovative approach to use CHWs to diagnose and treat children with SAM outside of health facilities. Phase 1 of the study was very successful, with results showing that:

• an increase in treatment coverage from 43.9% to 86.7% in the area where the CHWs approach was tested (from coverage surveys conducted before and after the intervention),
• treatment default rates less than half compared with the standard CMAM approach in health facilities,
• cure rates higher than International Sphere standards,
• quality of care provided by CHWs were high quality,
• the intervention was cost-effective compared to the traditional approach in health facilities.

Impact: The use of Community Health Workers to diagnose and treat severe acute malnutrition outside of the health facilities has the potential to become a global approach that could be tested and delivered in other countries and contexts. With this aim, Action Against Hunger is actively working to contribute to the global evidence base with three additional pilot studies testing this approach.

Donors: innocent foundation

Partners: INRSP (Institute National de Recherche et Santé Publique), National Nutrition Direction of the Ministry of Health and Bamako University

More information and related documents:

• Find a summary of the evidence in Mali as well as in Pakistan here.
• Quality of care for treatment (J. L. Alvarez Morán et al., 2017) The majority of SAM-affected children were correctly assessed for the presence of major clinical signs as well as of danger signs.
• Effectiveness of treatment (J. L. Alvarez Morán et al., 2018) CHWs treated and rehabilitated the large majority of children enrolled in the programme. They reduced the risk of children abandoning treatment before completing it.
• Cost-effectiveness of treatment (E. Rogers et al., 2018) The delivery of treatment by CHWs is a cost-effective intervention, a major benefit of this strategy was the lower cost incurred by the beneficiary household when treatment is available in the community.
• Trial registration: http://www.isrctn.com/ISRCTN33578874

Phase 1: Pakistan

From 2014 to 2016 with the Ministry of Health and the Agan Kan University worked with 75 Lady Health Workers (LHWs). The objective was to test an innovative approach to diagnose and treat children with SAM outside of the health facilities. Phase 1 of the study was successful, with results showing that:

• the coverage assessment was the same in the control and intervention approach,
• in both groups, cured, defaulters and deaths rates respect the Standard Sphere,
• quality of care provided by LHWs was high,
• the intervention was cost-effective compared to the traditional approach in health facilities.

Impact: The use of Lady Health Workers to diagnose and treat severe acute malnutrition outside of the health facilities has the potential to become a global approach that could be tested and delivered in other countries and contexts.

This evidence suggested that adequate training and on-the-job support are critical to ensuring acceptable levels of quality in the delivery of SAM treatment and other services. More research is needed to model the intervention in Pakistan.

Donors: innocent foundation

Partners: Ministry of Health and Aga Kan University

More information and related documents:

• Rogers et al. 2019. Evaluation of the cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by lady health workers as compared to an outpatient therapeutic feeding programme in Sindh Province, Pakistan
• Find a summary of the evidence in Mali as well as in Pakistan here.
• Rogers et al. 2017. Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan. 

Phase 1: Niger

From November 2017 until May 2019, a pilot study is ongoing in Maradi Region, Mayahi district, at 12 health facilities with 12 CHWs.

The main objective is to increase coverage of SAM treatment with CHWs. The questions the research will address are:

• Is SAM treatment delivered through CHWs as effective (cure, death and defaulters rates) as SAM treatment delivered at health facilities?
• Will access and coverage in the communities where CHWs deliver SAM treatment increase after 12 months?
• Do cases treated by CHWs show fewer complications?
• Is there a correlation between MUAC admission or weight-for-height (PT) admission and length of stay?
• What is the correlation between MUAC and the weight-to-height index for identifying a child with MAS?

Results are ongoing

Donors: OFDA

Partners: Direction National de Sante Publique (DNSP) in Niger, together with the Centre de Recherche Medicale et sanitaire (CERMES)

Trial Registration available here.

Phase 1: Mauritania

From November 2017 until May 2019, a pilot study is running in Guidimakha region, district of Selibaby at 8 health facilities with 12 CHWs.

The main objective is to increase coverage of SAM treatment with CHWs. The questions the research will address are:

• Is SAM treatment delivered through CHWs as effective (cure, death and defaulters rates) as SAM treatment delivered at health facilities?
• Will access and coverage in the communities where CHWs deliver SAM treatment increase after 12 months?
• Do cases treated by CHWs show fewer complications?
• Are CHWs capable of providing quality SAM case management?
• Are CHWs able to monitor and provide quality nutritional data
• Does the management of acute malnutrition make it possible to reduce the drop-out rate and length of stay compared with CEP in health facilities

Results are ongoing 

Donors: OFDA 

Partners: Direction de Sante de Base et Nutrition (DSBN) in Mauritanie, UNICEF, Institut National de Recherche en Santé (INRSP), la faculté des sciences et techniques de l’université de Nouakchott.  

Read more about C-Project Phase 2 here