Expanding Community Management of Malnutrition in Nigeria

The Challenge

Severe acute malnutrition (SAM), or extremely low weight-for-height, is estimated to affect 500,000-1,000,000 children under age five in Nigeria every year, contributing to as many as 100,000 deaths per year. Community-based management of acute malnutrition (CMAM), a proven intervention for treating SAM, has been launched in 11 northern states of Nigeria, but the treatment is estimated to cover only 15-25% of the national burden of SAM each year.

The Opportunity

The CMAM approach trains community volunteers to identify and initiate treatment for children with acute malnutrition before they become seriously ill. In this model, community volunteers screen children for SAM. Those who are deemed to be severely malnourished are given calorie- and nutrient-dense Ready-to-Use-Therapeutic Foods (RUTF) weekly for four to eight weeks until normal nutritional status is restored. The subset of children suffering from additional serious medical complications is referred to hospital care.

The CMAM program in Nigeria is expected to have a large impact in a highly cost-effective manner. It will create one of the largest CMAM programs in the world, treating 1 million Nigerian children with SAM and saving an estimated 95,000 lives over the next five years. But the true cost of CMAM in Nigeria is not yet known, and there is an urgent need to measure these costs and program impacts and to calculate the resulting cost-effectiveness.

Our Work

The Children’s Investment Fund Foundation (CIFF) is funding the expansion of CMAM in 11 states in northern Nigeria over a two-year timeframe beginning in 2013. To complement this support, CIFF has asked R4D to perform prospective cost data collection to validate the ex-ante estimates of the program’s cost-effectiveness and to ensure that financial support to sustain the program will be mobilized.

By providing insight into both of these areas, R4D will contribute to the global evidence base on the cost effectiveness of routine CMAMs (CMAM has proved its worth in emergency situations, but has only begun to be applied in routine circumstances of chronic malnutrition) and provide useful inputs into discussions between the Government of Nigeria and external donors on how to sustainably finance and scale the program.

R4D is conducting this work, which complements its ongoing work in Nigeria in support of the Saving One Million Lives initiative, in collaboration with the Federal Ministry of Health, UNICEF, Action Contre la Faim, Valid, and Save the Children. R4D has contracted with Health System Consult Limited, a Nigerian consulting organization, to work directly with R4D on the cost data collection.

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