Effectiveness and policymaking surrounding combined protocol for treatment of acute malnutrition in food-crisis affected contexts

Grant awarded: £213,950

Lead organisation: International Rescue Committee

Project length: 18 months

Study locations: Karaan Health Center in Karaan District, Benadir Region, South Central Somalia

Principal Investigator: Naoko Kozuki

  • Ibrahim Mahmoud, an IRC clinical officer in Mogadishu, examines a malnourished child who has been hooked up to an intravenous drip bottle. Credit: Peter Biro/IRC


The combined protocol for acute malnutrition simplifies the existing treatment protocol of community-based management of acute malnutrition (CMAM) by 1) treating severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) as one condition on a spectrum, 2) provides one product for treatment (ready-to-use therapeutic food, RUTF), 3) diagnoses children on mid-arm circumference and oedema, and 4) simplifies the dosage protocol (two RUTF sachets/day for MUAC <115mm, one RUTF sachet/day for MUAC 115-<125mm). While this is a protocol endorsed by the World Food Program (WFP) in emergency contexts, there is limited evidence on its effectiveness and a lack of understanding of the barriers to adoption in crisis-affected contexts

The objectives of the study are:

1. To determine if acutely malnourished children (6-59 months) treated under the combined protocol meet the Sphere minimum standard of 75% recovery rate in a nutrition clinic in Karaan District, Somalia.

2. To document the clinical staff’s perspectives on ease, workload, and effectiveness of implementing the combined protocol compared to the CMAM protocol.

3. To conduct policy analysis on use of the combined protocol in five different food-crisis affected contexts to describe how the protocol was presented regarding its benefits, requirements for implementation, and boundaries. This analysis will be conducted ultimately to understand requirements for adaptation and adoption of the protocol in different contexts, and examine the factors that influence policy change.

Expected outcomes:

We anticipate our study will show that health outcomes of those treated by the combined protocol meet the Sphere humanitarian standards for both SAM and MAM treatment (≥75% recovery, <15% default, <3% death for MAM, same standards except <10% death for SAM). If we observe that the new protocol meets Sphere humanitarian standards and better understand the policy context for uptake of the protocol, we can effectively advocate for the protocol to be rolled out in more contexts where logistical challenges prevent or hinder effective implementation of CMAM. Under the dire conditions of the food crisis-affected contexts, an effective and efficient integrated treatment model has potential to increase treatment coverage, reduce severe cases, decrease cost, and reduce preventable deaths without a need for dramatic changes to the current infrastructure or logistical systems.

IRC F&N Call-01

Elrha is a registered charity in England and Wales (1177110).

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