ArticleThe American journal of clinical nutrition2026
Integrated community case management plus compared with outpatient therapeutic programs: a quasi-experimental study among children with severe acute malnutrition in Jowhar, Somalia.
Article in The American journal of clinical nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWHO guidelines endorse treatment of severe acute malnutrition (SAM) by community health workers as an alternative to facility-based care, but supportive evidence for this shift is low.
objectivesAmong Somali children with uncomplicated SAM, we compared recovery between facility-based outpatient therapeutic programs (OTP) and integrated community case management (iCCM+), examining weight change, length of stay, discharge anthropometry, and overall anthropometric change.
methodsIn a quasi-experimental study (3 January-19 May, 2024), children with uncomplicated SAM [weight-for-height Z-scores (WHZ) < -3 SD and/or mid-upper arm circumference (MUAC) ≤115 mm] were enrolled for treatment in OTP (2 sites, 638 children) or iCCM+ (8 villages, 545 children). During weekly follow-up visits, children received nutritional assessments, ready-to-use therapeutic food, and routine medications until discharge (MUAC >115mm; WHZ > -3SD). Weight change and time-to-recovery were analyzed using generalized linear mixed-effects models and Cox proportional hazards models, respectively. To adjust for baseline differences in observed covariates, we used propensity score adjustment.
resultsAt enrolment, OTP children had more severe anthropometric deficits than their peers in the iCCM+ group (WHZ<-3SD: 48% compared with 42%, P = 0.04; MUAC ≤110 mm: 34% compared with 18%, P < 0.001). Recovery proportions were similar between groups (iCCM+: 89%; OTP: 91%). In adjusted analyses, no difference was observed in weight change over time. The iCCM+ group had a shorter median length of stay (by 7 d) and faster time-to-recovery (adjusted hazard ratio: 3.32, 95% CI: 2.70, 4.09).
conclusionsTreatment outcomes were similar between approaches; iCCM+ enabled earlier identification and shorter length of stays, suggesting improved efficacy and reduced burden on caregivers and health systems. It shows promise for expanding SAM treatment in settings with limited OTP access.
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