Factors affecting decision-making on use of combined/ simplified acute malnutrition protocols in Niger, north-east Nigeria, Somalia and South Sudan

A policy study was undertaken by the International Rescue Committee to analyse factors affecting decision-making on use of combined/simplified acute malnutrition protocols in Niger, north-east Nigeria, Somalia and South Sudan. Fifty respondents were interviewed from Ministries of Health, United Nations agencies and non-governmental organisations. Simplified protocols are currently implemented in exceptional circumstances in all four contexts. Respondents appreciated the rationale and benefits of combined protocols, but there is reluctance by national governments to depart from global guidelines without stronger evidence and World Health Organization-endorsed global guidance. ere is confusion around terminology and concerns regarding implications of mid-upper arm circumference-only programming and ready-to-use therapeutic food supply-chain resourcing and management. Discussions are largely confined to humanitarian circles, largely driven by UNICEF, ECHO and the Nutrition Cluster. Findings highlight opportunities and an urgent need for global research and collaboration around combined protocols to generate scientific evidence and examine implications for health systems.