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Combining Treatment of Acute Malnutrition With Integrated Community Case Management: A Cluster-Randomised Controlled
Gael Cronin1, Mohamed Jelle1, Shukri Ali2
1UCL Institute for Global Health, Institute of Child Health, London, UK.
Maternal & Child Nutrition
|May 24, 2026
Summary
Integrated community case management (iCCM) shows potential for improving acute malnutrition treatment coverage in remote settings. However, challenges with diagnosis accuracy and relapse rates require further investigation and improved training for family health workers.
Area of Science:
- Global Health
- Pediatric Nutrition
- Public Health Interventions
Background:
- Acutely malnourished children in resource-limited settings face challenges in treatment access and outcomes.
- Integrated community case management (iCCM) programs offer a promising approach to address these challenges.
- Limited evidence exists on the effectiveness of integrating malnutrition treatment into iCCM.
Purpose of the Study:
- To evaluate the impact of integrating malnutrition treatment into iCCM programs on treatment coverage and outcomes.
- To compare outcomes between standard iCCM and iCCM with community-level malnutrition treatment provided by family health workers (FHWs).
Main Methods:
- A cluster randomized controlled trial was conducted in Somaliland, comparing standard iCCM with iCCM+ (malnutrition treatment at village level).
- Coverage was assessed via household cohorts, and treatment outcomes were monitored in an open cohort of identified cases.
- Malnutrition was diagnosed using mid-upper arm circumference (MUAC) and weight-for-height z-scores (WHZ).
Main Results:
- Prevalence of acute malnutrition was significantly lower when diagnosed by MUAC compared to WHZ (3% vs. 13%), leading to underpowering.
- While the intervention arm showed a higher likelihood of initiating treatment (71.9%), improvements in overall coverage were not statistically significant.
- Higher rates of relapse and non-response were observed in the intervention arm, alongside high rates of misdiagnosis by FHWs (67.4%-77.4%).
Conclusions:
- Integrating malnutrition treatment into iCCM may enhance treatment initiation in resource-limited settings.
- Significant challenges exist, including diagnostic accuracy and increased relapse/non-response rates, necessitating enhanced training and supervision for FHWs.
- Further research is needed to optimize the integration of malnutrition treatment within community-based health programs.
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