Factors that influence acute malnutrition detection and treatment by community health promoters in Samburu and Turkana counties, Kenya: A mixed methods study

Global acute malnutrition (GAM) among children <5 years contributes to mortality and is a persistent problem in the drylands of Africa, including Samburu and Turkana Counties in Kenya, due to recurring droughts and other factors. In 2023, GAM prevalence was 20.3% in Samburu and 34.8% in Turkana, far exceeding the emergency threshold of 15%. Community health promoters (CHPs) are frontline members of the community health system who work with families to detect, treat, and refer acute malnutrition cases, but little is known about factors associated with these tasks. We conducted a mixed-method study with a convergent parallel design as part of the Nawiri program in Samburu and Turkana Counties to better understand how training, supervision, self-efficacy, social and peer support, supplies and equipment, stipends, and motivation affect whether CHPs carry out GAM detection and treatment. Outcome data on GAM detection and treatment were compiled from CHPs' monthly reports. Survey data on factors that influence GAM detection and treatment were collected from all CHPs in selected community health units on the same days as monthly meetings. The quantitative data were analyzed using structural equation modeling. Focus group discussions with CHPs to gather information that complemented the survey data and key informant interviews with community health assistants to understand the challenges CHPs face were conducted and analyzed using thematic content analysis methods. A total of 490 CHPs were enrolled - more than half were women. CHP self-efficacy and work non-self-determined motivation (W-NDSM) were positively associated with GAM detection but work self-determined motivation (W-SDM) had no direct effect on GAM detection. CHP self-efficacy, W-SDM, and W-NDSM had no direct effect on GAM treatment. Qualitative findings revealed that CHPs were motivated by support received through supervision, social and peer networks, and community recognition. However, CHPs faced challenges such as irregular training sessions, insufficient supplies, and community hostility. Strengthening CHP training, supervision, and support systems is essential for improving the detection and treatment of acute malnutrition. Addressing barriers such as supply shortages and community hostility, while enhancing motivation through recognition and support, may lead to better detection and treatment of acute malnutrition in these counties.