Evaluating the Performance of Integrated Management of Acute Malnutrition Programs in Somalia: A Systematic Review...

Background: Globally, acute malnutrition remains a significant public health challenge. Severe acute malnutrition (SAM) is the most lethal type of acute malnutrition. This study aimed to produce pooled estimates of the effectiveness of integrated management of acute malnutrition (IMAM) programs in addressing SAM in Somalia. Methods: Medline, Embase, Cochrane, Web of Science, CINAHL, ProQuest, Google Scholar, eLENA, and the UNICEF website were searched with no language or date restrictions. Random effect models were used to estimate the pooled estimates of outpatient therapeutic program (OTP) and stabilization centres (SC) performance outcomes (I² > 50%). Results: Of 186 identified studies, three included data from IMAM programs in Somalia but were excluded, as they had incomplete data. Included were seven datasets identified through the authors' list, which screened 36.34 million and admitted 2.31 million (6.35%) children aged 6-59 months. The pooled estimates of IMAM performance outcomes [%, (95% confidence interval)] for OTPs and SCs were, respectively, 2.45 (2.18, 2.56) and 4.11 (95%CI: 3.33, 4.90) for relapse, 95.39 (94.87, 95.90) and 80.81 (79.25, 82.37) for recovery, 0.18 (0.15, 0.21) and 1.73 (1.51, 1.95) for death, 2.57 (2.34, 2.79) and 2.75 (2.37, 3.12) for defaulter, 1.86 (1.55, 2.17), and 0.84 (0.66, 1.02) for non-recovery. Conclusions: OTP and SC performance outcomes in Somalia exceeded the Sphere Minimum Standards and compare favourably with results from the region. The adaptation of IMAM programs to meet multiple challenges in Somalia, supported by well-designed, coordinated, standardized, integrated, and harmonized implementation plans, is a strength.