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.

[Infant feeding practices in Nouakchott: between medical guidelines and grandmothers’ instructions]. / Alimentation des nourrissons à Nouakchott?: entre recommandations médicales et instructions des grand-mères.

The World Health Organization recommends exclusive breastfeeding up to the age of six months and continuation of partial breastfeeding up to the age of two years, in addition to nutritionally adequate and safe food. In Mauritania, despite some progress, most mothers do not comply with these recommendations. The aim of this study, conducted in Nouakchott, was to evaluate breastfeeding and feeding practices, and measure factors associated with achievement of the optimal duration of exclusive breastfeeding. The methodology combined quantitative and qualitative approaches. A descriptive cross-sectional study was conducted by questionnaires among 330 mothers from different departments of the capital. Twenty semi-structured interviews were then conducted with Mauritanian grandmothers in order to understand their roles and perceptions about infant feeding. Before the age of 6 months, the exclusive breastfeeding rate was 18.4%, the predominant breastfeeding rate was 44.3% and the partial breastfeeding with milk rate was 28.1%. In addition, 9.2% of infants received supplementary feeding. We found that 50.5% of mothers were aware of the optimal duration of exclusive breastfeeding, but only 14.2% complied with this recommendation. The factors significantly associated with compliance with the optimal duration of exclusive breastfeeding were maternal age over 35 years and multiparity. Interviews revealed that grandmothers knew about some of the nutritional recommendations, but denied their relevance based on their experience. Their advice contradicted certain medical recommendations. Our study revealed inadequacies concerning the mother's knowledge and more frequently their practices in terms of infant feeding. The gap between knowledge and practice can be essentially explained by the relative importance attributed to recommendations by the mothers, as well as the confrontation between medical recommendations and grandmothers' traditional knowledge.