CORE Group Global Health Practitioner Conference Fall 2017

1. From Harm to Home | Rescue.org
Enabling low-literacy community health
workers to treat uncomplicated SAM as part
of iCCM in Aweil South County, South Sudan
Annie Zhou, Nutrition Specialist
28 September 2017
CORE Group Conference

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From Harm to Home | Rescue.org
Aweil South County, South Sudan
• GAM rate of 20.2% (2017)
• SAM rate of 4.6% (2017)
• 60% of severely
malnourished children not
receiving treatment
• Largest barrier: distance
• CHWs:
o 99.7% female
o 0.5% formally educated

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Research Study
To assess whether CHWs in Aweil South County, South
Sudan can use simplified tools adapted for low literacy to
treat SAM without medical complications
1) Design stage
• Final adjustments made to low-literacy tools
• Simplified protocol finalized
2) Implementation feasibility stage
• Can CHWs demonstrate high performance in treating SAM
cases in the community
• Do treatment outcomes meet acceptable standards

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From Harm to Home | Rescue.org
MUAC Tape

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Dosage Scale

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Dosage Calculator

8. Patient Register

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Implementation feasibility stage
1) Training and skills assessment of 60 CHWs
2) 44 high performers deployed to provide SAM
treatment in their home communities

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CHW Skills Assessment
Critical items included danger sign
assessment, MUAC measure, appetite
test, correct dosage, use of the register
•CHW performance score
o Average 93%
o Range 68% to 100%
•91% passed at a priori determined
standard of 80%
•49% had perfect scores

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From Harm to Home | Rescue.org
Treatment in the
Community
• 310 children enrolled and
discharged
• Biweekly supervision
• Tracked CHW
performance, treatment
outcomes, time to
discharge, RUTF supply,
incorrect enrollment,
“double-dipping”
• FGDs and KIIs with key
stakeholders

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From Harm to Home | Rescue.org
Preliminary Results
Indicator Study (n) Study (%) SPHERE
Standard
Total Discharged 197
Cured 149 75.6% 75%
Death 0 0.0% 10%
Default 30 15.2% 15%
Non-Response 18 9.1% -
Transfer 113

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From Harm to Home | Rescue.org
Learnings (so far)
1) CHWs are able to implement the simplified protocol
with the aid of appropriately adapted tools and
trainings
2) Overwhelming demand for SAM treatment services
in South Sudan

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From Harm to Home | Rescue.org
More to come…
Analysis and dissemination
• Winter 2017 / Spring 2018
RISE for Nutrition Grant
• In partnership with Action Against Hunger, Concern
Worldwide, Malaria Consortium, and Save the
Children
• Testing simplified tools and protocol in 3 additional
countries: Kenya, Malawi, and Nigeria
• Funded by Eleanor Crook Foundation

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From Harm to Home | Rescue.org
Thank you!
For more information:
Annie Zhou
Nutrition Specialist
Annie.Zhou@rescue.org
Naoko Kozuki
Technical Advisor for Health
Research
Naoko.Kozuki@rescue.org