Reasons for dropouts in a community-based Management Acute Malnutrition (CMAM) program using local foods in the Far North of Cameroon.

INTRODUCTION: The security crisis caused by the Islamic sect Boko Haram, coupled with arid climatic conditions and a context of poverty, has preyed on populations in the far north of Cameroon, exacerbating malnutrition rates among children under five years old. New evidence has shown that many children with moderate acute malnutrition (MAM) can be treated in their communities (CMAM) without having to be admitted to a health center or therapeutic feeding center. The purpose of our study was to identify factors that may lead to beneficiary dropout in a CMAM program in four health districts in the far north of Cameroon. METHODS: A retrospective descriptive study of children who exited the CMAM program as lost to follow-up. Trained CHWs interviewed mothers in the households of children identified as lost to follow-up in the CMAM program using a questionnaire. The data were analyzed using STATA software. The confidence interval used was 95% and a P-value of 5%. RESULTS: Seven hundred and ten children were identified as being lost to the CMAM program, 686 of whom were present in the households during the interviews. Boys were 40.20%; girls 59.79% and the median age was 19 months. In the post-CMAM period, boys (OR=0.64; p=0.018); children in Moulvoudaye health district (OR=0.32; p=0.0025), and households with ≥10 people were at lower risk of MAM. The risk of being MAM was higher in households located 6-10 km and -=10km from a health facility (OR=4.21, +0.0001). Vitamin A Supplementation (OR=0.37; p=0.0131) and dietary diversity (OR=0.60; p=0.0773) protected children from MAM. The main reasons for dropping out of the CMAM program cited by parents were that health personnel and CHWs had declared and discharged the child as cured (44.4%); mothers received information that the project was over (17.54%); and mothers had traveled (10.2%). Other reasons: parents not keeping appointments (4.5%); children not responding to treatment (4.8%); shortage of food supplies (3.1%); and the long distance between the distribution site and the household (5.6%) etc. Conclusion: Several children were discharged as dropouts while they were still active. These included discharge errors and those due to the end of the project. Distance, stock shortages, failure to keep appointments, parental relocation, and illnesses in children were all reasons for the high dropout rate. We recommend strengthening the quality of training for health personnel and CHWs on the CMAM protocol before implementation.

Community-Based Surveillance: Knowledge and skills of Community Health Workers in epidemics setting in Ganjuwa LGA, Nigeria.

INTRODUCTION: Community-based surveillance (CBS) is essential for early detection and prompt response to epidemic-prone diseases (EPD). Community Health Workers (CHWs), trained in basic healthcare services, can play a vital role in this process. Like many Local government Areas (LGA) in Nigeria, between January and September 2023, Ganjuwa LGA in Bauchi state was facing a simultaneous outbreak of measles, pertussis, Diphtheria, and Lassa Fever. METHODS: Descriptive cross-sectional study among the CHWs in the Ganjuwa LGA to assess their knowledge and skills in CBS of EPD by using a questionnaire. Exhaustive sampling of CHWs implicated in CBS in Ganjuwa LGA and who gave verbal consent were included. Stata 16.0 software was used for analysis. The final score of knowledge of CHWs on CBS was calculated with the rate of the total best answers given by the CHWs based on five questions fixed. RESULTS: The study enrolled 71 CHWs with a majority being male (61.97%) and an average age of 27 years. The education level of the CHWs varied, with 61.97% having completed secondary school, 29.58% having a university education, and 8.45% having completed primary school. In terms of experience, the majority of CHWs had 1 year of experience (73.24%), followed by 2 years (15.49%). The findings revealed that only a small percentage of CHWs (23.94%) recognized that Ganjuwa LGA was affected by four outbreaks, and 35.21% were aware that EPD could be transmitted through various means in communities. The overall knowledge score of the CHWs was relatively low, with a mean score of 0.4 (ranging from 0 to 1). Most CHWs had a score of 0.2, while only 5.63% achieved a score of 1. On the positive side, a significant majority of CHWs felt comfortable conducting home visits to identify suspected cases of EPD (76.06%) and expressed confidence in their ability to educate community members about disease surveillance and reporting (71.83%). Additionally, a majority of CHWs were familiar with the process of collecting and recording data related to EPD at the community level (64.79%). Most CHWs also expressed willingness to undergo additional training to improve their knowledge and skills in CBS (64.79%) and reported working well with local health facilities and authorities for information sharing and collaboration on disease surveillance efforts (73.24%). CONCLUSION: Overall, these findings highlight both strengths and areas for improvement in the knowledge, skills, and attitudes of CHWs regarding disease surveillance and reporting in the community. Targeted training interventions can help address the gaps identified and further enhance the effectiveness of CHWs in their roles.