KENYA
Working with the Kenyan government and our partners, we conducted a randomised cluster control trial (RCT) in 2019 IN northern Kenya to examine the efficacy of CHW treatment compared to facility-based care. The results showed:
- CHW treatment is at least as safe and effective, or more, than care provided at the facility level
- Children were more likely to complete their full treatment and recovered more quickly
- Preliminary analysis suggested this approach may also be more cost effective
Thanks to the success of this research, the Kenyan government is exploring policy change to enable CHWs to treat children with malnutrition. The evidence was also fed into WHO’s review of wasting guidelines, which now endorse CHW treatment, providing they receive adequate training, supervision and resource.
A number of research briefs have been produced based on the findings from the RCT:
- Research brief: 'Treatment of Moderate Acute Malnutrition by Community Health Volunteers is Cost-Effective: Insights from Turkana County, Kenya' 2023
- Research brief: 'The community has good perceptions towards the management of acute malnutrition by community health volunteers: Findings from a qualitative study in Northern Kenya' 2023
- Communication brief: 'Bridging the Gap' 2021
A wider pilot led and funded by UNICEF with Kenyan research partners is planned to start in early 2024 in Turkana, Marsebit and Mandera counties. It seeks to evaluate the capability of trained, supervised, and well-equipped Community Health Providers (CHPs), as well as looking at coverage, treatment outcomes and cost efficiency/cost effectiveness of ICCM and CHV treatment of SAM /MAM.
A number of evidence products will be published in early 2024 to feed into our national discussion around policy change.
SOMALIA
Nutrition is a significant public health concern in Somaliland. Malnutrition rates in children under five years of age are among the highest in the world, with an estimated 19.7% Global Acute Malnutrition (GAM) rate, according to the latest Save the Children SMART Survey conducted in Awdal region in 2022.
An effectiveness randomised control trial in Somaliland is currently underway to test the effectiveness of the Female Health Workers (FHW) delivering Community-based Management of Acute Malnutrition (CMAM) programme and treating malnourished children in the remote areas that have no functioning health care or primary healthcare. The aim of the research is to provide evidence on the treatment of acute malnutrition at household level by Family Health Workers (FHWs). The treatment will be provided as an additional service within the ICCM programme and is therefore referred to as iCCM Plus. The study will compare ICCM Plus treatment with facility-based treatment using a cluster, controlled trial design. The baseline has been completed and programme implentation will kick off in January 2024.
