Effectiveness and Coverage of Severe Acute Malnutrition Treatment with a Simplified Protocol in a Humanitarian Context in Diffa, Niger

Abstract

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 (p value = 0.001). There was no difference between the groups in the length of stay, which was 35 days, but the intervention group used a lower quantity of RUTF—70 sachets versus 90 sachets, per child cured. Coverage increases were observed in both groups. Discussion: the simplified protocol used at the HCs and HPs did not result in worse recovery and resulted in fewer discharge errors compared to the standard protocol.

Comparing time to recovery in wasting treatment: simplified approach vs. standard protocol among children aged 6–59 months in Ethiopia—a cluster-randomized, controlled, non-inferiority trial

“…This similarity persisted even after employing the shared gamma frailty model ( P = 0.575), indicating clustering or heterogeneity in both SAM and MAM groups. These findings are consistent with previous studies conducted in various regions of Africa, supporting the consistency of non-inferiority in average length of stay and time to cure between simplified and standard treatment approaches ( 8 – 11 , 14 , 39 ). These findings altogether have strong programmatic and policy implications.…”

“…In studies conducted in various regions of Africa, the duration of treatment and recovery time for children with acute malnutrition using a modified dosage was similar to the standard protocol ( 8 – 11 , 14 , 39 ). In this study, we set out to compare the recovery time of a simplified approach with the standard protocol in the treatment of acute malnutrition (specifically uncomplicated SAM and MAM in children aged 6–59 months) to provide context-specific evidence for treatment effectiveness.…”

Cost of Acute Malnutrition Treatment Using a Simplified or Standard Protocol in Diffa, Niger

“…The cost of treating one child with SAM was USD 31.4 in Kabléwa and USD 21.2 in the simplified protocol area. It is worth noting that the reduction in dose did not appear to have a negative impact on recovery rates [13]. The modelled scenario sensitivity analysis showed that, all other things being equal, the difference in RUF costs remains, thus providing robust evidence for cost savings in terms of RUF where the simplified protocol was used.…”

“…In 2021, Action Against Hunger, in collaboration with the Centre de Recherche Médicale et Sanitaire in Niger (CERMES), the Nutrition Division of the Ministry of Health in Niger and EPINUT research group from the Complutense University of Madrid (Spain), conducted an operational research project comparing effectiveness of acute malnutrition treatment with a standard and simplified protocol decentralised to the village level in an emergency context in Diffa region, Niger. In this study, the recovery rate among children treated with a simplified protocol was 96.6% while the recovery rate among those treated with the standard protocol was 87% [13]. In the latter group, children were required to recover based on two criteria (MUAC and WHZ), while recovery of children in the simplified protocol group was by MUAC only.…”

“…Data on the number of admissions, number of RUTF or RUSF sachets provided and length of stay was obtained from the main study database. The methods and data on treatment outcomes of the main study have been published in detail elsewhere [13]. In brief, it was planned to include all children aged 6-59 months with moderate or severe acute malnutrition enrolled for treatment at one of the participating health centres or health posts during a 6-month period from November 2020 to April 2021.…”