Characteristics and outcomes in children aged 6 to 60 months assessed as being malnourished by community health workers in Tlokwe

Abstract

Background: Severe acute malnutrition (SAM) is a common problem with severe and long-lasting effects. As part of the primary health care re-engineering team, community health workers (CHWs) are well placed to screen for and refer SAM patients at an early stage. Few studies have investigated the role of CHWs in SAM referrals and clinical outcomes in South Africa, and none in the North West province. Aim: To compare the outcomes of admission between children referred by CHW to Potchefstroom hospital for SAM and those by other healthcare workers. Setting: This study was conducted in a primary healthcare setting in JB Marks subdistrict, Tlokwe municipal area, North West Province, South Africa. Methods: A cross-sectional study that analysed 71 medical records of children admitted with SAM from 1 April 2016 to 31 March 2018 was conducted. Referral forms from outreach teams to clinics were used to establish CHW involvement in the referral of patients with SAM. Chi squared, t-tests and ANOVA determined associations between referral sources and outcomes. The effect size of differences in outcome were calculated to determine the practical significance. Results: Only 5 out of 71 (7.04%) SAM patient admissions were due to CHW referrals from the community. Patients referred by CHWs showed statistically significant higher Hb levels compared to other sources of referral (p 0.044). No deaths were associated with CHW-referred patients compared to six in the clinic-referred group and three in the other-referred group. Other outcomes were not statistically different. Conclusion: This study found that community health worker referrals contributed to a small proportion of SAM admissions, implying that they did not consistently screen for malnutrition in this community