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Ilboudo PG, Donfouet HPP, Wilunda C, Cichon B, Tewoldeberhan D, Njiru J, Keane E, Mwangi B, Mwaniki E, Zerfu TA, Schofield L, Maina L, Kutondo E, Agutu O, Okoth P, Raburu J, Kavoo D, Karimurio L, Matanda C, Mutua A, Gichohi G, Kimani-Murage E. Treatment of moderate acute malnutrition through community health volunteers is a cost-effective intervention: Evidence from a resource-limited setting. MATERNAL & CHILD NUTRITION 2024:e13695. [PMID: 39016674 DOI: 10.1111/mcn.13695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/17/2024] [Accepted: 06/13/2024] [Indexed: 07/18/2024]
Abstract
Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case management (iCCM). However, little is known about the cost-effectiveness of this integrated nutrition intervention. The present study investigates the cost-effectiveness of treating moderate acute malnutrition (MAM) through community health volunteer (CHV) and integrating it with routine iCCM. A cost-effectiveness model compared the costs and effects of CHV sites plus health facility-based treatment (intervention) with the routine health facility-based treatment strategy alone (control). The costing assessments combined both provider and patient costs. The cost per DALY averted was the primary metric for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's relative value for money was evaluated using the most recent country-specific gross domestic product threshold metrics. The intervention dominated the health facility-based strategy alone on all computed cost-effectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per death and DALY averted of US$ 8743 and US$ 397, respectively, as opposed to US$ 13,846 and US$ 637 in the control group. The findings also showed that the intervention group spent less per child treated and recovered than the control group: US$ 214 versus US$ 270 and US$ 306 versus US$ 485, respectively. Compared with facility-based treatment, treating MAM by CHVs and health facilities was a cost-effective intervention. Additional gains could be achieved if more children with MAM are enrolled and treated.
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Affiliation(s)
- Patrick G Ilboudo
- Health and Wellbeing Theme, African Population and Health Research Center, Nairobi, Kenya
| | - Hermann Pythagore Pierre Donfouet
- Health and Wellbeing Theme, African Population and Health Research Center, Nairobi, Kenya
- Health Nutrition and Population Global Practice, The World Bank, Washington, USA
| | - Calistus Wilunda
- Health and Wellbeing Theme, African Population and Health Research Center, Nairobi, Kenya
| | | | | | - James Njiru
- Save the Children International, Kenya & Madagascar Programme, Nairobi, Kenya
| | | | - Bonventure Mwangi
- Health and Wellbeing Theme, African Population and Health Research Center, Nairobi, Kenya
| | - Elizabeth Mwaniki
- Health and Wellbeing Theme, African Population and Health Research Center, Nairobi, Kenya
| | - Taddese Alemu Zerfu
- Health and Wellbeing Theme, African Population and Health Research Center, Nairobi, Kenya
- Development Strategies and Governance Unit, International Food Policy Research Institute (IFPRI), Addis-Ababa, Ethiopia
| | | | - Lucy Maina
- Country Office, UNICEF Kenya, Nairobi, Kenya
| | | | | | - Peter Okoth
- Country Office, UNICEF Kenya, Nairobi, Kenya
| | | | - Daniel Kavoo
- Division of Community Health, Ministry of Health, Nairobi, Kenya
| | - Lydia Karimurio
- Division of Neonatal and Child Health, Ministry of Health Kenya, Nairobi, Kenya
| | - Charles Matanda
- Division of Neonatal and Child Health, Ministry of Health Kenya, Nairobi, Kenya
| | - Alex Mutua
- Division of Neonatal and Child Health, Ministry of Health Kenya, Nairobi, Kenya
| | - Grace Gichohi
- Division of Nutrition and Dietetics, Ministry of Health, Nairobi, Kenya
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Cichon B, López-Ejeda N, Mampindu MB, Bagayoko A, Samake M, Cuellar PC. Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300431. [PMID: 38901972 PMCID: PMC11216703 DOI: 10.9745/ghsp-d-23-00431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/14/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Enabling community health workers (CHWs) to treat acute malnutrition improves treatment access and coverage. However, data on the cost and cost-effectiveness of this approach is limited. We aimed to cost the treatment at scale and determine the cost-effectiveness of different levels of supervision and technical support. METHODS This economic evaluation was part of a prospective nonrandomized community intervention study in 3 districts in Mali examining the impact of different levels of CHW and health center supervision and support on treatment outcomes for children with severe acute malnutrition. Treatment admission and outcome data were extracted from the records of 120 participating health centers and 169 CHW sites. Cost data were collected from accountancy records and through key informant interviews. Results were presented as cost per child treated and cured. Modeled scenario sensitivity analyses were conducted to determine how cost-efficiency and cost-effectiveness estimates change in an equal scale scenario and/or if the supervision had been done by government staff. RESULTS In the observed scenario, with an unequal number of children, the average cost per child treated was US$203.40 in Bafoulabé where a basic level of supervision and support was provided, US$279.90 in Kayes with a medium level of supervision, and US$253.9 in Kita with the highest level of supervision. Costs per child cured were US$303.90 in Bafoulabé, US$324.90 in Kayes, and US$311.80 in Kita, with overlapping uncertainty ranges. CONCLUSION Additional supervision has the potential to be a cost-effective strategy if supervision costs are reduced without compromising the quality of supervision. Further research should aim to better adapt the supervision model and associated tools to the context and investigate where efficiencies can be made in its delivery.
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Affiliation(s)
| | - Noemí López-Ejeda
- EPINUT Research Group, Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | | | - Aliou Bagayoko
- Nutrition Direction of the Ministry of Hygiene and Public Health, Bamako, Mali
| | - Mahamadou Samake
- Nutrition Direction of the Ministry of Hygiene and Public Health, Bamako, Mali
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Sánchez-Martínez LJ, Charle-Cuéllar P, Gado AA, Dougnon AO, Sanoussi A, Ousmane N, Lazoumar RH, Toure F, Vargas A, Hernández CL, López-Ejeda N. Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger. Front Nutr 2023; 10:1253545. [PMID: 38099186 PMCID: PMC10719846 DOI: 10.3389/fnut.2023.1253545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Of the 45.4 million children under five affected by acute malnutrition in the world, the majority (31.8 million) are affected by moderate acute malnutrition (MAM). Its treatment is particularly complex in emergency settings such as the Diffa region in Niger. This study aims to evaluate the effectiveness and coverage of a simplified treatment protocol with Community Health Workers (CHWs) as treatment providers. Methods This study is a non-randomized controlled trial. The control group (n = 181) received the standard protocol currently used in country, delivered by nursing staff only in health centres and health posts, while the intervention group (n = 483) received the simplified protocol which included nursing at health centres and CHWs at health post as treatment providers. Results The recovery rate was higher in the simplified protocol group (99.6% vs. 79.56%, p < 0.001) recording lower time to recover and higher anthropometric gain. Treatment coverage in the intervention group increased from 28.8% to 84.9% and reduced in the control group (25.3% to 13.6%). No differences were found in the recovery rate of children treated by CHWs and nursing staff. Conclusion The outcomes using the simplified protocol exceeded humanitarian requirements and demonstrated improvements compared to the standard protocol showing that the simplified protocol could be safely provided by CHWs in an emergency context. Further research in other contexts is needed to scale up this intervention.
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Affiliation(s)
- Luis Javier Sánchez-Martínez
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | | | | | | | - Atté Sanoussi
- Nutrition Direction, Ministry of Health, Niamey, Niger
| | | | | | - Fanta Toure
- Action Against Hunger, West and Central Africa Regional Office, Dakar, Senegal
| | | | - Candela Lucía Hernández
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | - Noemí López-Ejeda
- Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
- EPINUT Research Group (Ref. 920325), Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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