COMMUNITY PARTICIPATION IN COMMUNITY-BASED MANAGEMENT OF ACUTE MALNUTRITION (CMAM) IN BAUCHI STATE, NIGERIA: LEVEL OF ENGAGEMENT AND BARRIERS TO EFFECTIVENESS

Résumé fourni par la source

Community-Based Management of Acute Malnutrition (CMAM) has been implemented in Bauchi State, Nigeria, to address the high burden of acute malnutrition among children under five. The success of CMAM depends heavily on community participation and the practices of community health workers (CHWs) and caregivers. However, limited evidence exists on the level of community engagement and barriers affecting effective participation.This study assessed community participation in CMAM interventions and ascertained the practices of CMAM among community health workers and caregivers in Bauchi State, Nigeria. A descriptive cross-sectional survey was conducted among 385 respondents (193 males, 192 females) selected from five Local Government Areas (Bauchi, Kirfi, Ningi, Ganjuwa, Katagum) using multistage sampling. Data were collected using a validated structured questionnaire (Cronbach's α = 0.908) and analyzed using descriptive statistics (frequencies, means, standard deviations) and inferential statistics (one-sample t-test) at 0.05 significance level. Self-reported CMAM practice was significantly high (grand mean = 3.42, SD = 1.01; t(384) = 20.64, p < .001). Respondents demonstrated proficiency in MUAC measurement (M = 4.52), RUTF administration (M = 4.22), and monitoring practices (M = 4.26). However, critical practice gaps were identified: failure to refer complicated SAM cases (M = 2.73), sharing RUTF among siblings (M = 3.05), inadequate breastfeeding counseling (M = 2.85), and insufficient follow-up support (M = 2.88). Community participation was significantly high (M = 35.71, SD = 4.76; t(384) = 23.52, p < .001), with active volunteer engagement (M = 4.06), leader advocacy (M = 4.18), and functional feedback mechanisms (M = 4.10). However, participants perceived CMAM as an "external project" (M = 3.68), indicating participation remains at consultative/tokenistic levels rather than genuine community ownership.While Bauchi State demonstrates strong foundational practices and active community engagement in CMAM, critical clinical decision-making gaps and tokenistic participation threaten program effectiveness. Competency-based training, community governance committees with decision-making authority, and multi-sectoral integration with food security programs are urgently needed to enhance program sustainability and child survival outcomes.

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