Screening for Acute Childhood Malnutrition during the National Nutrition Week in Mali Increases Treatment Referrals

Abstract

ObjectiveTo evaluate a pilot intervention designed to integrate mid-upper arm circumference (MUAC) screening for acute malnutrition into the semi-annual Child Nutrition Week (Semaine d'Intensification des Activités de Nutrition, or “SIAN”) activities carried out in June 2008.DesignA cross-sectional survey was conducted in Kolokani and Nara, two health districts in the Koulikoro region of Mali, 4–5 months after the SIAN, using a population-proportionate, multi-stage random sample of: 1) health centers, and 2) households in communities linked to each of the selected health centers. Caregivers of 1543 children who were 6–59 months of age at the time of the SIAN, 17 community-based volunteers and 45 health center staff members were interviewed.ResultsA total of 1278 children 6–59 months (83% of those studied) reportedly participated in SIAN. Of the participating children, 1258 received vitamin A (98% of SIAN participants; 82% of all eligible children), 945 received anti-helminth tablets (84% of participants; 71% of eligibles), and 669 were screened for acute malnutrition (52% of participants; 43% of eligibles). 186 of the children screened (27%) were reportedly identified as acutely malnourished. SIAN screening covered a significantly greater proportion of children than were examined in both community-based (22% of children) and health center-based screening activities (5% of children) combined during the 4-5 months after the SIAN (P<0.0001). In general, community volunteers and health personnel positively evaluated their experience adding MUAC screening to SIAN.ConclusionIntegrating MUAC screening for acute malnutrition in SIAN permits the assessment of a large number of children for acute malnutrition, and should be continued.

Use of Mid-Upper Arm Circumference by Novel Community Platforms to Detect, Diagnose, and Treat Severe Acute Malnutrition in Children: A Systematic Review

“…The difference in screening coverage was substantial: 52% of eligible children (those in the 6–59-month age range) were screened during the event, compared with 22% screened at health centers and 5% screened in the community in the months following the event. 28 The discrepancies in screening rates suggest that both facility and community-based SAM screening have considerable room for improvement: half of the children with acute malnutrition in their survey had been at a health center within the previous 4 months, but only a quarter of them had been assessed for malnutrition.…”

“…This may partially explain why screening rates and detection of SAM cases remain low even at clinics where staff have been trained in CMAM protocols. 28 If the findings by Blackwell et al (2015) hold true, further simplifying the MUAC protocol may address issues of familiarity and understanding of MUAC among health care providers and caregivers alike. 10 …”

“…Several studies indicate that the use of MUAC by caregivers and CHWs is a missing link in the integration of SAM care into other platforms, be it integration with MAM programming; 27 , 33 integration into nutrition or health-focused events such as nutrition weeks, vaccination campaigns, nutrition events, water, sanitation, and hygiene (WASH) programming, or well-baby clinics; 28 , 34 or incorporating MUAC assessment and treatment into existing iCCM programs. 35 As many of the studies reviewed in this article suggest, and as reported by a study of the integration of SAM care into Niger's national health system, the complexity of acute malnutrition intervention protocols (multiple indicators, treatment types, locations, and steps in care) hinders integration.…”

Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali

“…Supplementary foods, personnel and infrastructure each contributed an important proportion to total MAM treatment costs, but none materially influenced conclusions regarding the overall cost-effectiveness of MAM treatment. Community-based screening, which has the potential to promote early case finding and increase treatment referrals,25 represented a relatively small sum in the management of acute malnutrition. Greater investment in increasing screening frequency or improving screening efficiencies, such as through increased community mobilisation, could increase programme coverage, reduce per-capita fixed costs associated with treatment and prevent the more costly management of complicated cases.…”

Impact on child acute malnutrition of integrating small-quantity lipid-based nutrient supplements into community-level screening for acute malnutrition: A cluster-randomized controlled trial in Mali

“…In Mali, a survey listed the low coverage of screening for AM as an important barrier to adequate CMAM treatment coverage [14]. Also in Mali, another study found that over a 4- to 5-month period, only 22% of children were screened by CHVs and 5% by health center staff [15]. These findings stress the need to boost screening coverage and increase caregivers’ knowledge and awareness of AM and of the existing local CMAM services.…”