Today global acute malnutrition (GAM) continues to threaten the lives of over 50 million children under-5 globally. Of them, severe acute malnutrition (SAM), affects up to 17 million, with a high risk of near term mortality. But there is an effective treatment.

Since 2007, the Community–based treatment of Acute Malnutrition (CMAM) approach has resulted in a significant increase in the number of children with uncomplicated SAM who are successfully treated in an outpatient health centre using Ready to Use Therapeutic Food (RUTF). More than 70% of children treated are cured but less than 1 out of 5 of children affected are able to access the treatment they need.


From 2014 to 2016, a pilot study was developed in the Kayes Region, Kita district, at 9 health facilities with 18 Community Health Workers (CHWs). The objective was to test an innovative approach to use CHWs to diagnose and treat children with SAM outside of health facilities. Phase 1 of the study was very successful, with results showing that:

  • an increase in treatment coverage from 43.9% to 86.7% in the area where the CHWs approach was tested (from coverage surveys conducted before and after the intervention),

  • treatment default rates less than half compared with the standard CMAM approach in health facilities,

  • cure rates higher than International Sphere standards,

  • quality of care provided by CHWs were high quality,

  • the intervention was cost-effective compared to the traditional approach in health facilities.


The use of Community Health Workers to diagnose and treat severe acute malnutrition outside of the health facilities has the potential to become a global approach that could be tested and delivered in other countries and contexts. With this aim, Action Against Hunger is actively working to contribute to the global evidence base with three additional pilot studies testing this approach in Kenya, Mauritania and Niger.

DONORS: innocent foundation

PARTNERS: INRSP (Institute National de Recherche et Santé Publique), National Nutrition Direction of the Ministry of Health and Bamako University

CONTACT: Pilar Charle Cuellar, Principal Investigator

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The effectiveness of treatment for Severe Acute Malnutrition (SAM) delivered by community health workers compared to a traditional facility based model

J. Alvarez Morán et al. 2018

Quality of care for treatment of uncomplicated severe acute malnutrition delivered by community health workers in a rural area of Mali

J. Alvarez Morán et al. 2017

Cost-effectiveness of the treatment of uncomplicated severe acute malnutrition by community health workers compared to treatment provided at an outpatient facility in rural Mali

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