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Principal Investigators: Noemi Lopez-Ejeda, ACF and Saul Guerrero, Independent (co-PI)


The study in Mali and Niger will investigate a modified protocol for treatment of severe acute malnutrition delivered by Community Health Workers (CHWs) and compare it to the current Community Management of Acute malnutrition (CMAM) protocol. The approach has significant potential to increase coverage and cure rates in remote contexts with limited accessibility to health facilities.  The results of our intervention could contribute to reduce costs and time of mothers and communities to treat children with severe acute malnutrition.

Noemi Lopez-Ejeda

Principal Investigator

Severe acute malnutrition remains a major public health problem that still affects 16.6 million children under 5 years of age in the world. The development of Ready-to-Use Therapeutic Foods in the 2000s was a revolution that brought treatment closer to families. Unfortunately, with the current model of outpatient treatment at health centers, only 40% of the children who need it are being reached

Noemi Lopez-Ejeda

Principal Investigator

The inclusion of Community Health Workers in the treatment of severe acute malnutrition with a new protocol based on simplified approaches could be that new revolution we are looking for. It could bring the treatment even closer by eliminating the main access barriers by reducing time and costs for families and this could help detect cases in less severe conditions. It would also allow a more integrated treatment with other infectious diseases that can also enhance the recovery making the intervention more cost-effective

Expected Outcomes

Research findings could contribute to a significant improvement in coverage and cost saving in crisis-affected areas where access to health services is a major issue.

Effectiveness of a new intervention model with CHWs

  • Evidence on the performance of the SAM care delivered by CHWs.
  • Evidence on the performance of the SAM care delivered using a modified protocol based on simplified approaches.
  • Evidence of an increase in the coverage of SAM treatment

Contribution to the continuity of care

  • Improvement of the continuum of care for SAM children across all levels of the health pyramid, starting from the Hospital (SAM children with complications), to the health center (SAM children without complications – CMAM Approach), through to community-level care delivered by CHWs (SAM children without complications – iCCM approach).

Cost-effectiveness of the intervention

  • Cost-effectiveness analysis of the different models of SAM treatment.
  • Evidence on the reduction of costs for household and of treatment duration.
These women from the Kita region of Mali are gathered for an awareness raising session on nutrition and health. These sessions are run by local community health workers. Photo copyright Action Against Hunger/ Toby Madden.

Research Methodology (Brief Summary)

A cluster Randomised Control Trial (cRCT) with three arms in each country.

  • Group 1: Control Arm = SAM treatment delivered at health centers (HC) applying standard CMAM protocol.
  • Group 2: Intervention Arm 1 = SAM treatment delivered both at HC and by CHWs applying standard CMAM protocol.
  • Group 3: Intervention Arm 2 = SAM treatment delivered both at HC and by CHWs applying the modified protocol based on simplified approaches.

We will consider two independent variables: treatment provider (HC/HC+CHWs) and protocol applied in the case of CHWs areas (CMAM/Modified). The main dependent variables to compare within SAM children will be the rates of: recovery (discharge as cured), default (children absent two consecutive visits), unresponsiveness (children not improving nutritional status in two consecutive visits), transfer (to inpatient treatment) and death. Other variables will be severity, prevalence of non-severe complications, length of stay and average daily weight and MUAC gain.

A coverage assessment and a cost effectiveness analysis will be developed to complete the study.

Related Resources

Article, Peer Reviewed Nutrition

Impact of a simplified treatment protocol for moderate acute malnutrition in Niger

Article, Peer Reviewed Nutrition

Effectiveness of decentralizing outpatient acute malnutrition treatment and a simplified combined protocol in Mali

Article, Peer Reviewed Nutrition

Cost of Acute Malnutrition Treatment Using a Simplified or Standard Protocol in Diffa, Niger

Article, Peer Reviewed Nutrition

Effectiveness and Coverage of Severe Acute Malnutrition Treatment with a Simplified Protocol in a Humanitarian Context in Diffa, Niger

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