Task-Shifting Malnutrition Screening: Evaluating Community Health Worker-Led Mid-Upper Arm Circumference Assessments on Referral Completion in Kayes, Mali

{ "background": "In rural Mali, health system constraints often limit the reach of nutrition services. Community health workers (CHWs) are a critical human resource, but their role in systematic malnutrition screening is not fully optimised.", "purpose and objectives": "This study assessed whether task-shifting moderate acute malnutrition (MAM) screening to CHWs using mid-upper arm circumference (MUAC) tapes improves the rate of completed referrals to therapeutic feeding programmes.", "methodology": "A quasi-experimental design compared referral completion in intervention villages (CHW-led MUAC screening) and control villages (standard facility-based screening). A total of 1,240 children aged 6-59 months were enrolled. The primary outcome, referral completion, was analysed using a logistic regression model: (P()) = \β0 + \β1 + \β X + \ε, with robust standard errors clustered by village.", "findings": "Referral completion was significantly higher in the intervention group (78.4%) compared to the control group (51.2%). The adjusted odds ratio was 3.42 (95% CI: 2.15 to 5.44), indicating a strong, statistically significant effect of the CHW-led intervention.", "conclusion": "Task-shifting MAM screening to CHWs using MUAC tapes is an effective strategy to increase the proportion of identified children who complete referrals to nutritional support in a rural Sahelian context.", "recommendations": "National nutrition programmes should integrate CHW-led MUAC screening as a core component of community-based management of acute malnutrition. Investment in sustained training, supervision, and a reliable supply of MUAC tapes is essential.", "key words": "task-shifting, community health workers, mid-upper arm circumference, malnutrition screening, referral completion, Mali", "contribution statement": "This study provides novel evidence that decentralising MAM screening to the community level