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Cost-effectiveness of community-based screening and treatment of moderate acute malnutrition in Mali
  1. Sheila Isanaka1,
  2. Dale A Barnhart2,
  3. Christine M McDonald3,
  4. Robert S Ackatia-Armah4,
  5. Roland Kupka5,
  6. Seydou Doumbia6,
  7. Kenneth H Brown4,
  8. Nicolas A Menzies7
  1. 1Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  2. 2Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  3. 3Children’s Hospital Oakland Research Institute, Oakland, California, USA
  4. 4Department of Nutrition and Program in International and Community Nutrition, University of California, Davis, CA, USA
  5. 5United Nations Children’s Fund, Nutrition Section, New York, NY, USA
  6. 6Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technology of Bamako, Bamako, Mali
  7. 7Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Sheila Isanaka; sisanaka{at}


Introduction Moderate acute malnutrition (MAM) causes substantial child morbidity and mortality, accounting for 4.4% of deaths and 6.0% of disability-adjusted life years (DALY) lost among children under 5 each year. There is growing consensus on the need to provide appropriate treatment of MAM, both to reduce associated morbidity and mortality and to halt its progression to severe acute malnutrition. We estimated health outcomes, costs and cost-effectiveness of four dietary supplements for MAM treatment in children 6–35 months of age in Mali.

Methods We conducted a cluster-randomised MAM treatment trial to describe nutritional outcomes of four dietary supplements for the management of MAM: ready-to-use supplementary foods (RUSF; PlumpySup); a specially formulated corn–soy blend (CSB) containing dehulled soybean flour, maize flour, dried skimmed milk, soy oil and a micronutrient pre-mix (CSB++; Super Cereal Plus); Misola, a locally produced, micronutrient-fortified, cereal–legume blend (MI); and locally milled flour (LMF), a mixture of millet, beans, oil and sugar, with a separate micronutrient powder. We used a decision tree model to estimate long-term outcomes and calculated incremental cost-effectiveness ratios (ICERs) comparing the health and economic outcomes of each strategy.

Results Compared to no MAM treatment, MAM treatment with RUSF, CSB++, MI and LMF reduced the risk of death by 15.4%, 12.7%, 11.9% and 10.3%, respectively. The ICER was US$9821 per death averted (2015 USD) and US$347 per DALY averted for RUSF compared with no MAM treatment.

Conclusion MAM treatment with RUSF is cost-effective across a wide range of willingness-to-pay thresholds.

Trial registration NCT01015950.

  • moderate acute malnutrition
  • corn soy blend
  • CSB++
  • Super Cereal
  • ready to use supplementary foods
  • PlumpySup
  • cost
  • cost-effectiveness
  • Mali

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  • SI and DAB contributed equally.

  • Handling editor Sanni Yaya

  • Contributors SI designed the study; RA-A and CM collected the data; SI, DAB and NM conducted the data analysis; and SI, DAB and NM prepared the first draft of the manuscript. SI and DAB vouch for the accuracy and completeness of the data and analyses reported. All authors contributed to the interpretation of data, critically reviewed the manuscript and decided to publish the paper.

  • Funding This study was funded by UNICEF Mali and UNICEF West and Central Africa, the World Food Programme, the Goldman Fund and Helen Keller International. The CSB++ was donated by the World Food Programme, Rome, Italy; the ready-to-use supplementary food was donated by Nutriset, Malaunay, France. SI was supported by the Harvard University Committee of African Studies.

  • Disclaimer The study sponsors had no role in in the collection, analysis or interpretation of the data, in writing of the report or in the decision to submit for publication.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The trial was approved by the Nutrition Division of the Ministry of Health of Mali, and the Ethical Review Committees of the Faculty of Medicine of the University of Bamako, the University of California, Davis and Boston University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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