학술논문
The Impacts of Task Shifting on the Management and Treatment of Malnourished Children in Northern Kenya: A Cluster-Randomized Controlled Trial.
Document Type
Academic Journal
Author
Donfouet HPP; The World Bank Health Nutrition and Population Global Practice, 1818 H Street, NW Washington, D.C. 20433 USA.; African Population and Health Research Center, P.O. Box 10787-00100, APHRC Campus, Kitisuru, Nairobi, Kenya.; Daniel T; UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya.; Wilunda C; African Population and Health Research Center, P.O. Box 10787-00100, APHRC Campus, Kitisuru, Nairobi, Kenya.; Mwaniki E; African Population and Health Research Center, P.O. Box 10787-00100, APHRC Campus, Kitisuru, Nairobi, Kenya.; Njiru J; Save the Children International, 3rd Floor ABC Place Waiyaki Way, Westlands Box 19423, 00202 KNH Nairobi, Kenya.; Keane E; Save the Children UK, St Vincent House 30 Orange Street London WC2H 7HH, United Kingdom.; Schofield L; Save the Children UK, St Vincent House 30 Orange Street London WC2H 7HH, United Kingdom.; Maina L; UNICEF Kenya, UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya.; Kutondo E; UNICEF Kenya, UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya.; Agutu O; UNICEF Kenya, UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya.; Okoth P; UNICEF Kenya, UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya.; Raburu J; UNICEF Kenya, UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya.; Samburu B; UNICEF Kenya, UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya.; Mwangi B; African Population and Health Research Center, P.O. Box 10787-00100, APHRC Campus, Kitisuru, Nairobi, Kenya.; Zerfu TA; African Population and Health Research Center, P.O. Box 10787-00100, APHRC Campus, Kitisuru, Nairobi, Kenya.; International Food Policy Research Institute, P.O. Box 5689, Addis Ababa, Ethiopia.; Wekhomba JK; Action Against Hunger-Kenya, Old Dagoretti Estate, House 26, Off Ngong Road 13-Amboleli Road P.O. Box: 39900-00623, Nairobi, Kenya.; Cuellar PC; Action Against Hunger, 6 Mitre Passage, London SE10 0ER, United Kingdom.; Kavoo D; Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya.; Karimurio L; Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya.; Matanda C; Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya.; Mutua A; Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya.; Gichohi G; Ministry of Health, P.O. Box 30016-00100, Nairobi, Kenya.; Chabi M; World Health Organization, U-Block, Third floor, United Nations Office in Nairobi, Kenya.; Codjia P; UNICEF Kenya, UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya.; Oteyza SG; UNICEF Headquarters, New York, USA.; Kimani-Murage E; African Population and Health Research Center, P.O. Box 10787-00100, APHRC Campus, Kitisuru, Nairobi, Kenya.
Source
Publisher: Oxford University Press in association with the London School of Hygiene and Tropical Medicine Country of Publication: England NLM ID: 8610614 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1460-2237 (Electronic) Linking ISSN: 02681080 NLM ISO Abbreviation: Health Policy Plan Subsets: MEDLINE
Subject
Language
English
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 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 two 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 program 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.
(© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)
(© The Author(s) 2024. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)