Effectiveness of Task Shifting in the Management of Malnourished Children in Northern Kenya: A Cluster-Randomized Controlled Trial
Year: 2024
Type: conference-paper
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Treating children with acute malnutrition can be challenging, particularly regarding access to healthcare facilities during treatment. Task shifting, a strategy of transferring specific tasks to health workers with shorter training and fewer qualifications, is being considered as an effective approach to enhancing health outcomes in primary healthcare. This study aimed to assess the effectiveness of integrating the treatment of acute malnutrition by community health volunteers (CHVs) into integrated community case management (iCCM) in two sub-counties in northern Kenya (Loima and Isiolo). We conducted a two-arm non-inferiority cluster-randomized controlled trial across 20 community health units. Participants were children aged 6-59 months with uncomplicated acute malnutrition. In the intervention group, CHVs used simplified tools and protocols to identify and treat eligible children at home and provided the usual iCCM package. In the control group, CHVs provided the usual iCCM package only (screening and referral of the malnourished children to the health facilities). The primary outcome was recovery (MUAC ≥12.5 cm for two consecutive weeks). Results show that children in the intervention group were more likely to recover than those in the control group [73.3 vs. 50.3; risk difference (RD)=25.7% (95% CI 11.7 to 39.6) and risk ratio (RR)=1.53 (95% CI 1.18 to 1.97)]. The probability of defaulting was lower in the intervention group than in the control group: RD=-20.8% (95% CI -31.3 to -10.2) and RR=0.29 (95% CI 0.17 to 0.49). The intervention reduced the length of stay by about 13 days, although this was not statistically significant and varied substantially by sub-county. Integrating the treatment of acute malnutrition by CHVs into the iCCM program led to better malnutrition treatment outcomes. There is a need to integrate acute malnutrition treatment into iCCM and review policies to allow CHVs to treat uncomplicated acute malnutrition. Keywords: Task shifting, community health volunteers, non-inferiority cluster-randomized controlled trial, child malnutrition
Authors: Bonventure Mwangi1, Hermann Pythagore Pierre Donfouet1,2, Tewoldeberhan Daniel3, UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya, Calistus Wilunda1, Elizabeth Mwaniki1, James Njiru4, Save the Children International, 3rd Floor ABC Place Waiyaki Way, Westlands Box 19423, 00202 KNH Nairobi, Kenya., Emily Keane6, UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Lily Schofield5, 5Save the Children UK, St Vincent House 30 Orange Street London WC2H 7HH, United Kingdom, Lucy Maina6, 6UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Edward Kutondo6, 6UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Olivia Agutu6, 6UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Peter Okoth6, 6UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Judith Raburu6, 6UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Betty Samburu6, 6UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Taddese Alemu Zerfu1,7, Jemimah Khamadi Wekhomba8, 8Action Against Hunger-Kenya, Old Dagoretti Estate, House 26, Off Ngong Road 13-Amboleli Road P.O. Box: 39900-00623, Nairobi, Kenya, Pilar Charle Cuellar9, 9Action Against Hunger, 6 Mitre Passage, London SE10 0ER, United Kingdom, Charles Matanda10, 10Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya, Alex Mutua10, 10Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya, Grace Gichohi10, 10Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya, Martin Chabi11, Patrick Codjia6, 6UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Saul Guerrero Oteyza12, 12UNICEF Headquarters, New York, USA., Elizabeth Kimani-Murage1
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4406184422