Translating research into action: ALIMA’s experience in improving women and children’s health care in rural Niger

Ms Sonia Girle1, Mr Matt Cleary1, Dr Nikki Blackwell1,2

1ALIMA (The Alliance for International Medical Action), Dakar, Senegal,

2Department of Critical Care, University of Queensland, Brisbane, Australia

 

Purpose

Providing medical care in remote, fragile contexts like rural Niger presents many challenges. We will report on research into simple interventions that can easily be scaled-up.

Nature of topic

Since 2012, ALIMA has conducted research in Niger’s Mirriah District. A non-inferiority trial looked at the effectiveness of training mothers to screen children for malnutrition by using mid-upper arm circumference (MUAC) bracelets. A prospective cohort since 2015 assessed maternal risk factors for perinatal mortality.

Issues under consideration

Children often present late for malnutrition treatment, resulting in higher rates of hospitalizations. Currently, community health workers (CHW) screen children by MUAC in the community, but ALIMA saw potential for mothers screening in the home. ALIMA also works with traditional birth attendants to try to increase use of reproductive health services, and a prospective cohort analysis found maternal factors associated with perinatal mortality.

Outcomes and Conclusion

The zone where mothers screened children by MUAC, cases were detected earlier than in the CHW zone, with median MUAC at admission 1.6 mm higher (95%CI 0.65-1.87). (1) Children in the mothers’ zone were less likely to be hospitalized, especially at admission (RR: 0.09; 95%CI 0.03-0.25; p<0.001). In the prospective cohort, ALIMA found four maternal factors associated with perinatal mortality: ≥ 4 antenatal consultations (ANC) decreased risk (aOR: 0.59; 95%CI: 0.35–1.01; p=0.05); first pregnancy (aOR: 2.15; 95%CI: 1.30–3.55; p<0.01) and positive malaria test during ANC doubled risk (aOR: 2.61; 95%CI: 1.32–5.18; p<0.01); and severe anemia tripled risk (aOR: 3.05; 95%CI: 1.08–8.65; p=0.04).

Based on these results, training mothers to use MUAC bracelets is now being scaled-up in Niger, and risk factors for perinatal mortality can be easily identified during ANC.

(1) Alé FG, et al. Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers. Arch Public Health. 2016 (74:38).