Action against Hunger has contributed to the definition of new global protocols for treating child malnutrition

The World Health Organization has published updated guidelines for treating child undernutrition. Action Against Hunger has contributed to the definition of the new protocols by incorporating the treatment of acute malnutrition through community health workers (ICCM+). This is an important milestone that will help save the lives of millions of children around the world by bringing access to treatment closer and easier.

Severe acute malnutrition (SAM) is the most lethal form of malnutrition and a major threat to child survival; it is responsible for 45% of deaths in children under 5 years of age.

Action Against Hunger has been a key player in the development of these protocols, leading research in ICCM+ (door-to-door treatment of malnutrition). The work of the ICCM+ team has led to the inclusion of this approach to malnutrition care through community health workers in the revision of the World Health Organization's guidelines for the management of cases of malnutrition.

Action Against Hunger was the first organization to conduct several pilot studies for the extension of care for child acute malnutrition by community health workers. These agents are mostly women, who receive basic health training, and treat children in the very community where they live. Enabling these agents to treat acute malnutrition in their community breaks down barriers to access to health facilities, treating and curing twice as many children and reducing costs for families. Geographic and economic barriers to accessing health centers have been identified as causes of low treatment coverage (more than 50% of the population lives more than 5 km from health centers).

To find out more about the iCCM+ approach

En video

• The story of Hawa (English)
• La historia de Hawa (Español)

Folleto: 

• Community Health Workers addressing acute malnutrition (English)
• Tratar la desnutrición aguda a través de agentes de salud comunitarios (Español)
• Des agents de santé communautaires pour lutter contre la malnutrition aigüe (Français)

Publicaciones científicas:

• Alvarez Morán JL et al. Quality of care for treatment of uncomplicated severe acute malnutrition delivered by community health workers in a rural area of Mali. Matern Child Nutr. 2018 Jan;14(1):e12449. https://doi.org/10.1111/mcn.12449 
• Alvarez Morán et al. The effectiveness of treatment for Severe Acute Malnutrition (SAM) delivered by community health workers compared to a traditional facility based model. BMC Health Serv Res 18, 207 (2018). https://doi.org/10.1186/s12913-018-2987-z .
• Rogers, E et al. Cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by community health workers compared to treatment provided at an outpatient facility in rural Mali. Hum Resour Health 16, 12 (2018). https://doi.org/10.1186/s12960-018-0273-0
• Rogers E et al . Quality of care of treatment for uncomplicated severe acute malnutrition provided by lady health workers in Pakistan. Public Health Nutr. 2018 Feb;21(2):385-390. https://doi.org/10.1017/S1368980017002610  
• Rogers E et al. Evaluation of the cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by lady health workers as compared to an outpatient therapeutic feeding programme in Sindh Province, Pakistan. BMC Public Health. 2019 Jan 17;19(1):84. https://doi.org/10.1186/s12889-018-6382-9 
• López-Ejeda N et al. Can community health workers manage uncomplicated severe acute malnutrition? A review of operational experiences in delivering severe acute malnutrition treatment through community health platforms. Matern Child Nutr. 2019 Apr;15(2):e12719. https://doi.org/10.1111/mcn.12719
• López-Ejeda N et al. Bringing severe acute malnutrition treatment close to households through community health workers can lead to early admissions and improved discharge outcomes. PLoS One. 2020 Feb 5;15(2):e0227939. https://doi.org10.1371/journal.pone.0227939
• Charle-Cuéllar, P. et al. Impact of Different Levels of Supervision on the Recovery of Severely Malnourished Children Treated by Community Health Workers in Mali. Nutrients 2021, 13, 367. https://doi.org/10.3390/nu13020367
• Hussain, I.et al. Effectiveness of management of severe acute malnutrition (SAM) through community health workers as compared to a traditional facility-based model: a cluster randomized controlled trial. Eur J Nutr 60, 3853–3860 (2021). https://doi.org/10.1007/s00394-021-02550-y
• Charle-Cuéllar P et al. Effectiveness and Coverage of Treatment for Severe Acute Malnutrition Delivered by Community Health Workers in the Guidimakha Region, Mauritania. Children (Basel). 2021 Dec 4;8(12):1132. https://doi.org/10.3390/children8121132 
• Ogobara Dougnon A, et al. Impact of Integration of Severe Acute Malnutrition Treatment in Primary Health Care Provided by Community Health Workers in Rural Niger. Nutrients. 2021 Nov 14;13(11):4067. https://doi.org/10.3390/nu13114067
• Charle-Cuéllar, P et al. Scaling severe acute malnutrition treatment with community health workers: a geospatial coverage analysis in rural Mali. Hum Resour Health 20, 74 (2022). https://doi.org/10.1186/s12960-022-00771-8
• Charle-Cuéllar, P. et al. Effectiveness and Coverage of Severe Acute Malnutrition Treatment with a Simplified Protocol in a Humanitarian Context in Diffa, Niger. Nutrients 2023, 15, 1975. https://doi.org/10.3390/nu15081975
• Cichon, B et al. Cost of Acute Malnutrition Treatment Using a Simplified or Standard Protocol in Diffa, Niger. Nutrients 2023, 15, 3833. https://doi.org/10.3390/nu15173833
• Molanes-López e al. Cost-effectiveness of severe acute malnutrition treatment delivered by community health workers in the district of Mayahi, Niger. https://doi.org/10.1186/s12960-024-00904-1
• Sánchez-Martinez et al. Impact of a simplified treatment protocol for moderate acute malnutrition with a decentralized treatment approach in emergency settings of Niger. https://doi.org/10.3389/fnut.2023.1253545  
• López-Ejeda N et al. Effectiveness of decentralizing outpatient acute malnutrition treatment with Community Health Workers and a simplified-combined protocol: noninferiority cluster randomized controlled trial in emergency settings in Mali. https://doi.org/10.3389/fpubh.2024.1283148
• Cichon, B et al. Cost of Acute Malnutrition Treatment Using a Simplified or Standard Protocol in Diffa, Niger.  https://doi.org/10.3390/nu151738
• Cichon, B et al. Integration of Acute Malnutrition Treatment Into Integrated Community Case Management in Three Districts in Southern Mali: An Economic Evaluation. Glob Health Sci Pract. 2024 Jun 27;12(3):e2300431. (2024) https://doi.org/10.9745/GHSP-D-23-00431