Integrated community case management plus compared with outpatient therapeutic programs: a quasi-experimental study among children with severe acute malnutrition in Jowhar, Somalia

This quasi-experimental study from Jowhar District, Somalia compared treatment outcomes for uncomplicated severe acute malnutrition (SAM) in children aged 6–48 months enrolled in either facility-based outpatient therapeutic programs (OTP) or an integrated community case management plus (iCCM+) model delivered by community health workers (CHWs) at the household level. Both groups received the same treatment: weekly visits, therapeutic food, routine medication and nutrition counseling. The key finding was that recovery rates were comparable between groups (iCCM+: 89%; OTP: 91%). In addition, children in the community program recovered about a week faster, partly because CHWs could identify and enroll children earlier, before their condition became as severe. Attendance was also far better in the community model, with far fewer missed appointments (2% versus 20%). Overall, the findings support iCCM+ as an effective and operationally feasible strategy for SAM treatment in hard-to-reach humanitarian settings, reinforcing the 2023 WHO guidelines endorsing CHW-led care while contributing much-needed context-specific evidence from Somalia. Overall, the findings support iCCM+ as an effective and operationally feasible strategy for SAM treatment in hard-to-reach humanitarian settings, reinforcing the 2023 WHO guidelines endorsing CHW-led care while contributing much-needed context-specific evidence from Somalia.

The intervention was funded by United States Agency for International Development (USAID)–Bureau of Humanitarian Assistance, under award number 720BHA21GR00233. However, the research component did not receive external funding. USAID had no role in the design of the study; in the collection, analysis, and interpretation of data; or in writing the manuscript.