Rate of participation in bi‐monthly, community‐based screening for acute malnutrition in rural Mali, and factors associated with screening participation

Background Population‐based protocols for the treatment of acute malnutrition (AM) usually recommend periodic screening of pre‐school aged children and referral of those with AM to the nearest health care facility for out‐patient or in‐patient treatment. Objective To evaluate the rate of participation in community‐based screening for AM, and to examine factors associated with participation. Methods 7664 children living in communities linked to 12 health centers in rural Mali were identified through a community‐based census and invited to participate in 5 bi‐monthly rounds of screening for AM. Eligibility was defined as age 6–35 mo and free from AM during previous screening. AM was defined as a mid‐upper arm circumference (MUAC) < 12.5 cm or weight‐for‐length Z‐score (WLZ) < −2.0 of the 2006 WHO Growth Standards. Results The prevalence of moderate AM and severe AM in 5 rounds of screening was 18% (95% CI: 17%, 20%) and 4% (95% CI: 3%, 5%), respectively. Of those eligible to participate in ≥ 1 round, 67% (95% CI: 59%, 75%) participated at least once; of those eligible to participate in all 5 rounds, only 4% (95% CI: 3%, 6%) participated in all 5. Factors significantly associated with greater participation in screening were younger age, ethnic group and selected wealth indicators (p<0.001 for each). For age, rate of participation was 73% for children aged 6–11 mo, 68% for children aged 12–23 mo, and 55% for children aged 24–35 mo. Conclusions Continuous participation in screening for AM was very low. Programs should reconsider the optimal frequency of screening and how best to motivate participation, particularly among older pre‐school aged children. Grant Funding Source : UNICEF, Helen Keller International