International Rescue Committee's Community Management of Acute Malnutrition program

The International Rescue Committee (IRC) runs a number of different programs, but we are especially interested in their malnutrition programming.

IRC treats children suffering from malnutrition, in countries that are affected by high rates of malnutrition (such as Kenya, Chad, Mali and Ethiopia). The program used is Community Management of Acute Malnutrition (CMAM); see outline of this intervention in the figure below. CMAM is an extensively studied malnutrition treatment, where patients receive ready-to-use therapeutic food (RUTF) and other food products (alongside antibiotics and dewormers in some cases) and most studies report recovery in 53%-82% of participants.

CMAM begins with local community health worker networks, or sometimes the mothers themselves, who identify malnourished children by measuring their mid-upper arm circumference. This is typically measured via a Mid-Upper Arm Circumference (MUAC) tape. Once identified, children with severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) are additionally screened for significant medical complications (such as malaria) that might necessitate more intensive inpatient care. Children who do not have these complications receive CMAM treatment, an outpatient treatment that involves the provision of specific calorie and nutrient-rich foods (such as RUTF) alongside antibiotics and dewormers in some cases.¹ The exact CMAM protocol differs slightly between different countries and providers,² but tends to use RUTF food and a course of antibiotics for children suffering from SAM, and ready-to-use supplementary food (RUSF)³/ enriched flours for MAM.⁴

Figure 1: schematic of CMAM programming

While CMAM is used by a number of NGOs, we think that the IRC’s programs are likely to be especially impactful per dollar for a few reasons. First, they operate in areas where there are exceptionally high rates of malnutrition. In some of these regions, other NGOs are unable to operate (such as Tigray, an area in northern Ethiopia that other NGOs have avoided due to conflict).⁵ Second, they have deep expertise in treating malnutrition; IRC provides technical assistance to more than 30 malnutrition country programs, and their research was formative in the development of modern methods of treating malnutrition, such as CMAM. In general, they appear to be a research and evidence-led organization. Third, the available data from IRC suggests that their programs are well-run, with a relatively low default rate and a low cost per child reached.⁶ Finally, our conversations with other leaders within the CMAM space have also indicated that the IRC’s work is held in high esteem.⁷

The IRC has had difficulties in fundraising for their programs, leading to the closure of several CMAM programs in high-priority countries. We estimate that they have £2.4 million room for funding, to fund CMAM programs in countries such as Kenya and Mali.

Notes

1. Daures M, Phelan K, Issoufou M, Kouanda S, Sawadogo O, Issaley K, Cazes C, Séri B, Ouaro B, Akpakpo B, Mendiboure V, Shepherd S, Becquet R. New approach to simplifying and optimising acute malnutrition treatment in children aged 6-59 months: the OptiMA single-arm proof-of-concept trial in Burkina Faso. Br J Nutr. 2020 Apr 14;123(7):756-767. doi: 10.1017/S0007114519003258. Epub 2019 Dec 10. PMID: 31818335; PMCID: PMC7054246. ↩

2. Given the extent of childhood malnutrition and the existence of resource constraints (with statistics from 2019 indicating that merely 39.9% of the 14.3 million children afflicted with Severe Acute Malnutrition (SAM) received treatment), researchers have experimented with making minor modifications to Community Management of Acute Malnutrition (CMAM) protocols. The aim here is to be able to reach a larger number of children without sacrificing treatment efficacy; for example, research focuses on aspects such as the optimal treatment schedule, use of local foods alongside RUTF, etc. ↩

3. RUTF is an energy-dense, micronutrient-enriched paste designed for rapid weight gain—often based on peanut butter mixed with dried skimmed milk, vitamins and minerals. RUSF is similar, but has less energy density compared to RUTF. It is designed to prevent previously malnourished individuals from deteriorating into SAM. ↩

4. See ‘What is the program?’ https://www.givewell.org/international/technical/programs/combined-protocol-community-management-acute-malnutrition#Does_the_program_have_strong_evidence_of_effectiveness ↩

5. https://docs.google.com/document/d/168w-wQMnvzuUshq1P34qUubU4IPbufki/edit?usp=drive_web&ouid=111292844725988457070&rtpof=true ↩

6. See https://www.rescue.org/sites/default/files/2023-07/Simplified%20Protocol%2C%20IRC%20Research%20Summary_July7.pdf ↩

7. Conversations with Stronger Foundations for Nutrition members, and Taimaka ↩