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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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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 into integrated community case management 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, community health volunteers used simplified tools and protocols to identify and treat eligible children at home and provided the usual integrated community case management package. In the control group, community health volunteers provided the usual integrated community case management package only (screening and referral of the malnourished children to the health facilities). The primary outcome was recovery (MUAC ≥12.5 cm for 2 consecutive weeks). Results show that children in the intervention group were more likely to recover than those in the control group [73 vs 50; risk difference (RD) = 26% (95% CI 12 to 40) and risk ratio (RR) = 2 (95% CI 1.2 to 1.9)]. The probability of defaulting was lower in the intervention group than in the control group: RD = -21% (95% CI -31 to -10) and RR = 0.3 (95% CI 0.2 to 0.5). 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 community health volunteers into the integrated community case management programme led to better malnutrition treatment outcomes. There is a need to integrate acute malnutrition treatment into integrated community case management and review policies to allow community health volunteers to treat uncomplicated acute malnutrition.
Assuntos
Transtornos da Nutrição Infantil , Agentes Comunitários de Saúde , Revezamento de Tarefas , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Administração de Caso/organização & administração , Transtornos da Nutrição Infantil/terapia , Serviços de Saúde Comunitária/organização & administração , QuêniaRESUMO
Child undernutrition is a persistent challenge in arid and semi-arid areas due to low and erratic rainfall, recurrent droughts and food insecurity. In these settings, caregivers face several challenges in accessing health services for sick and/or malnourished children, including long distances to health facilities, harsh terrain, and lack of money to pay for transportation costs to the health facilities, leading to low service coverage and sub-optimal treatment outcomes. To address these challenges and optimize treatment outcomes, the World Health Organization recommends utilizing community health volunteers (CHVs) to manage acute malnutrition in the community. This study explored the perceptions of community members regarding acute malnutrition treatment by CHVs in Turkana and Isiolo counties in Kenya. The study utilized a cross-sectional study design and included a purposive sample of caregivers of children, CHVs, officers who trained and supervised CHVs and community leaders in the intervention area. Focus group discussions and key informant interviews were used to explore perceptions towards the management of acute malnutrition by CHVs. Generally, caregivers and CHVs perceived the intervention to be beneficial as it readily addressed acute malnutrition treatment needs in the community. The intervention was perceived to be acceptable, effective, and easily accessible. The community health structure provided a platform for commodity supply and management and CHV support supervision. This was a major enabler in implementing the intervention. The intervention faced operational and systemic challenges that should be considered before scale-up.
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Background and Objectives: Policy and program interventions for older adults 60 years or older in Africa have consistently been undermined by a lack of vital data as they are usually excluded from nationally representative population surveys. The Health and Wellbeing of Older Persons in Kenya (HWOPs-1) study developed a standardized assessment questionnaire that can be used for periodic data generation. This study presents how the questionnaire was developed and examines its internal consistency and psychometric properties of the health module. Research Design and Methods: The development and validation of the HWOPs-1 questionnaire was a 3-step process. Step 1 was a review of 19 panel studies and 2 national level surveys followed by a wide consultation with key experts and stakeholders on aging. The 3rd step was validation of the questionnaire with a cross-section of a representative sample to test its applicability and adaptability in a mix of rural and semi-urban settings. The internal consistency and psychometric properties of the 3 subscales: functionality, disability, and quality of life were assessed using Cronbach's (α) alpha and exploratory factor analysis, respectively. Results: Three subscales of functionality, disability, and quality of life showed high internal consistency with αâ =â 0.94, 0.97, and 0.87, respectively. There were also consistent factor loadings above 0.3 across all the factors. Gender differences across the 3 scales from the results of t test were observed. Finally, weak but statistically significant correlations between the measures of well-being and risk factors for noncommunicable diseases were also observed from the analyses. Discussion and Implications: The indicators assessed have been used in settings outside Africa to measure health and well-being of older adults are adaptable and reliable enabling comparability across space and across studies. The questionnaire provides a framework for examining disease and disability burden and their determinants among older adults in Kenya or similar settings.
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OBJECTIVE: To estimate the economic cost of GBV from the perspective of a women survivor who sought help from two identified programs (Makueni GBVRC and Life Bloom Services International [LBSI]). DESIGN: A mixed method research design combining qualitative and quantitative approaches. SITE: Makueni GBVRC in Makueni County, overseen by the Makueni County government, and LBSI in Naivasha, Nakuru County, a non-profit organization devoted to serving local communities. PARTICIPANTS: Study participants include women survivors of GBV, aged 18 and above, actively seeking services at Makueni GBVRC and LBSI. INTERVENTIONS: The study adopts a qualitative approach to delve into the intricate economic costs of GBV on survivors. Additionally, quantitative data analysis employs an accounting model to ascertain the financial implications. MAIN MEASUREMENTS: The costs analyses were done from the perspective of the women survivors. An accounting model was utilized to evaluate the cost of GBV on selected survivors. Furthermore, the research explores the enduring consequences for survivors, including psychological trauma and susceptibility to stress-related diseases. RESULTS: The findings reveal substantial economic costs linked to GBV, adversely affecting survivors, their children, and society at large. These costs encompass direct expenditures on medical care, legal representation, and counseling, as well as indirect costs, such as lost productivity. CONCLUSIONS: Beyond immediate and indirect costs, the study underscores the existence of opportunity costs-what survivors and affected children could attain in the absence of GBV.