Description of a community paediatric strategy offering a package of services to prevent malnutrition among children in one health district in Mali

Background We present results from an intervention case study, the Soins Preventifs de l Enfant (SPE) project, in Konseguela health area, Mali. The intervention involved a network of community health workers providing a comprehensive preventive/therapeutic package, ultimately aiming at reducing under 24-month mortality. Associated costs were documented to assess the feasibility of replication and scale-up. Methods SPE program monitoring data were obtained from booklets specific to the program between 2010 and 2014. Data included sex, age, vaccination status, anthropometric measurements, Ready-To-Use-Supplementary Food distribution, morbidities reported by the mother between visits, hospitalizations over 18 months of follow-up. Cross-sectional surveys in the district of Koutiala, of which Konseguela is one health area, were conducted yearly between 2010 and 2014 for comparison, using difference-in-difference approach. Ethical approval was granted from the Malian Ethical Committee. Results Global and Severe Acute Malnutrition prevalences decreased over time in Konseguela as well as in the rest of the district, but the difference between areas was not significant. Children reaching 24 months were 20% less stunted in Konseguela than children the same age outside (p<0.001). Mortality rates significantly decreased more in Konseguela, while vaccination coverage for all antigens significantly increased in the meantime. The package cost approximately USD 95 per child per year; 56% of which was for the RUSF. Conclusion The results of this case study suggest a sustained impact of a community based, comprehensive health package on major child health indicators. Most notably, while improvements in acute malnutrition were found in the district as a whole, those in the intervention area were more pronounced. Trends for other indicators suggest additional benefits.