Engaging caregivers in at-home surveillance of children with uncomplicated severe acute malnutrition

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Research snapshot¹

Although outpatient care has been shown to be highly effective, cost-effective and acceptable across a variety of settings, only 10% of children with severe acute malnutrition (SAM) receive treatment each year. Limited health infrastructures and trained personnel can constrain the number of children who receive treatment at facilities. Prior research in nutrition has shown that mothers have the ability to diagnose SAM immediately following training, similar to community health workers.

To assess the feasibility of shifting clinical surveillance to caregivers of children admitted for outpatient treatment of SAM, the authors conducted a pilot study in the Maradi region, Niger, to assess caregivers' understanding and retention of key concepts related to the surveillance of clinical danger signs and anthropometric measurement. At the time of a child's admission to outpatient SAM treatment, a nurse provided a short training (less than 30 minutes) to groups of no more than 10 caregivers on two topics: (a) clinical danger signs in children with SAM that warrant facility-based care and (b) methods to measure and monitor their child's mid-upper arm circumference (MUAC). Caregiver understanding was assessed using standardised questionnaires before training, immediately after training and 28 days after training.

A total of 128 caregivers of children aged 6 to 59 months with uncomplicated SAM were enrolled. Knowledge of most clinical danger signs (e.g., convulsions, oedema, poor appetite, respiratory distress and lethargy) was low (0–45%) before training but increased immediately after and was retained 28 days after training. The majority of caregivers correctly implemented the four steps to measure their child's MUAC immediately following training and the correct methods were retained 28 days after.

Results provide preliminary evidence to suggest that, with minimal training, caregivers with relatively low education can understand the key concepts of clinical warning signs and MUAC measurement for the surveillance of their malnourished children at home. Task-shifting of clinical and anthropometric surveillance to mothers may provide a feasible model to reduce the frequency of health facility visits, reduce the burden on resource-limited health systems and caregivers and help to detect clinical warning signs before serious complications develop in SAM children.

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