Distance From Treatment Is Associated With Poorer Admission Status and Worse Outcomes Among Acutely Malnourished Children.

Abstract

Distance from health facilities is an important predictor of treatment seeking and health outcomes. We aimed to describe the relationship between distance from care with admission characteristics and treatment outcomes among children admitted to malnutrition treatment. Data was collected as part of an observational study on the effectiveness of a simplified malnutrition treatment program in the Nara district of Mali. Treatment was provided at 37 health centers and 51 community health sites. Linear and logistics mixed models were fitted to estimate associations between distance from treatment with admission anthropometrics and programmatic outcomes. A total of 49,074 children with mid-upper arm circumference (MUAC) < 125 mm or edema were admitted to treatment between December 2018 and December 2023. Most (60%) lived within the village/town where treatment was provided (0 km) while 7%, 27% and 7% lived 1-5 km, 6-15 km and > 15 km from the treatment site, respectively. Up to 91% recovered attaining twice a MUAC ≥ 125 mm. Distance from treatment was consistently associated with lower anthropometrics at admission with 0.63, 1.38 and 2.18 mm lower MUAC among children living 1-5, 6-15, and > 15 km distance from the treatment site, respectively (p < 0.001), compared to 0 km. This suggests later treatment seeking among those living further from treatment. Living > 15 km from treatment site was associated with 49% increased risk of defaulting, 20% decreased risk of referral to inpatient care and 18% increased risk of missing a visit when compared to 0 km, and when adjusting for admission anthropometry. Poorer admission status and worse treatment outcomes are observed among children living farther from treatment sites, emphasizing the need to further decentralize malnutrition treatment.