Effectiveness and Coverage of Treatment for Severe Acute Malnutrition Delivered by Community Health Workers in the Guidimakha Region, Mauritania.

Geographical and economic access barriers to health facilities (HF) have been identified as some of the most important causes of the low coverage of severe acute malnutrition (SAM) treatment. The objective of this study is to assess the effectiveness and coverage of SAM treatment delivered by community health workers (CHWs) in the Guidimakha region in Mauritania, compared to the HF based approach. This study was a nonrandomized controlled trial, including two rural areas. The control group received outpatient treatment for uncomplicated SAM from HF, whilst the intervention group received outpatient treatment for uncomplicated SAM from HF or CHWs. A total of 869 children aged 6-59 months with SAM without medical complications were included in the study. The proportion of cured children was 82.3% in the control group, and 76.4% in the intervention group, we found no significant difference between the groups. Coverage in the intervention zone increased from 53.6% to 71.7%. In contrast, coverage remained at approximately 44% in the control zone from baseline to end-line. This study is the first to demonstrate in Mauritania that the decentralization model of CHWs treating SAM improves acute malnutrition treatment coverage and complies with the international quality standards for community treatment of acute malnutrition. The non-randomized study design may limit the quality of the evidence, but these results could be used by political decision-makers as a first step in revising the protocol for acute malnutrition management.

Upper arm length along with mid-upper arm circumference to enhance wasting prevalence estimation and diagnosis : sensitivity and specificity in 6 to 59 month-old children. (preprint)

Objective: To evaluate the added value of the use of upper arm length (UAL) along with MUAC (mid-upper arm circumference) to diagnose and estimate the prevalence of wasting in comparison to current WHO standard and others MUAC based methods. Design: We included UAL to usual anthropometric measurements during a Mauritanian national 6-59-month-old cross-sectional nutritional survey. Children were classified into 3 groups UALG1, UALG2 and UALG3 according to the following UAL limits: ≤ 150 mm, 151-180, and > 180mm respectively. We used a Receiver Operating Characteristic curve to determine the best MUAC cut-off for each group with weight-for-height Z score as a reference standard. We compared the wasting prevalence, sensitivity, and specificity, of all diagnostic methods. Findings: In total, 12 619 children were included in the study. Wasting prevalence was 16.1%, 5.0% and 12.5% when diagnosed by WHZ < -2, MUAC < 125 mm and MUAC-UALG methods respectively. Using the MUAC-UALG method increased the sensitivity for wasting diagnosis from 17.98 % with MUAC < 125 mm to 39.43% with MUAC-UALG. The specificity decreased from 97.49% with MUAC < 125 to 92.71% with MUAC-UALG. With MUAC-height Z score and MUAC < 138 mm, sensitivity was 26.04% and 69.76%and specificity were 97.40%and 75.64% respectively. Conclusion: This alternative method using MUAC measuring tape to measure UAL increases the wasting diagnosis accuracy and allows for a better estimation of wasting prevalence. This method could be used as a potential alternative method for quick surveys in emergency settings such as Corona virus disease 2019 context.