Treatment of Moderate Acute Malnutrition through Community Health Volunteers is a cost-effective Intervention: Evidence from a Resource-Limited Setting
Authors:   Health and Wellbeing Theme, African Population and Health Research Center,  APHRC Campus, Nairobi, Kenya, G. Ilboudo1 Patrick , Pythagore Pierre Donfouet1,2 Hermann ,   Health and Wellbeing Theme, African Population and Health Research Center, APHRC Campus, Nairobi, Kenya 2Health Nutrition and Population Global Practice, 1818 H Street, NW Washington, D.C. 20433 USA., Wilunda1 Calistus ,   Health and Wellbeing Theme, African Population and Health Research Center,  APHRC Campus, Nairobi, Kenya, Cichon3 Bernardette ,   Operations Department, Action Against Hunger, 6 Mitre Passage, London SE10 0ER, London, UK, Tewoldeberhan4 Daniel ,   UNICEF, UNICEF Eastern and Southern Africa Regional Office, Nairobi, Kenya, Njiru5 James ,   Save the Children International, 3rd Floor ABC Place Waiyaki Way, Westlands KNH Nairobi, Kenya., Keane6 Emily ,   Save the Children UK, St Vincent House 30 Orange Street London WC2H 7HH, United Kingdom, Mwangi1 Bonventure ,   Health and Wellbeing Theme, African Population and Health Research Center, APHRC Campus, Nairobi, Kenya, Mwaniki1 Elizabeth ,   Health and Wellbeing Theme, African Population and Health Research Center, APHRC Campus, Nairobi, Kenya, Alemu Zerfu1,7 Taddese ,   Health and Wellbeing Theme, African Population and Health Research Center, APHRC Campus, Nairobi, Kenya, International Food Policy Research Institute, Addis Ababa, Ethiopia, Schofield6 Lilly ,   Save the Children UK, St Vincent House 30 Orange Street London WC2H 7HH, United Kingdom, Maina8 Lucy ,   UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Kutondo8 Edward ,   UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Agutu8 Olivia ,   UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Okoth8 Peter ,   UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Raburu8 Judith ,   UNICEF Kenya Country Office, P.O. Box 44145-00100, Nairobi, Kenya, Kavoo9 Daniel ,   Division of Community Health, Ministry of Health, Nairobi, Kenya, Karimurio10 Lydia ,   Division of Neonatal and Child Health, Ministry of Health Kenya, Nairobi, Kenya, Matanda10 Charles ,   Division of Neonatal and Child Health, Ministry of Health Kenya, Nairobi, Kenya, Mutua10 Alex ,   Division of Neonatal and Child Health, Ministry of Health Kenya, Nairobi, Kenya, Gichohi11 Grace ,   Division of Nutrition and Dietetics, Ministry of Health, Nairobi, Kenya, Kimani-Murage1 Elizabeth ,   Health and Wellbeing Theme, African Population and Health Research Center, P.O. Box 10787-00100, APHRC Campus, Nairobi, Kenya
Published: January 2025

Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case
management (iCCM). However, little is known about the cost-effectiveness of this integrated nutrition
intervention. The present study investigates the cost-effectiveness of treating moderate acute malnutrition
(MAM) through community health volunteer (CHV) and integrating it with routine iCCM. A costeffectiveness model compared the costs and effects of CHV sites plus health facility-based treatment
(intervention) with the routine health facility-based treatment strategy alone (control). The costing
assessments combined both provider and patient costs. The cost per DALY averted was the primary metric
for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's
relative value for money was evaluated using the most recent country-specific gross domestic product
threshold metrics. The intervention dominated the health facility-based strategy alone on all computed costeffectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per
death and DALY averted of US$ 8743 and US$ 397, respectively, as opposed to US$ 13,846 and US$ 637
in the control group. The findings also showed that the intervention group spent less per child treated and
recovered than the control group: US$ 214 versus US$ 270 and US$ 306 versus US$ 485, respectively.
Compared with facility-based treatment, treating MAM by CHVs and health facilities was a cost-effective
intervention. Additional gains could be achieved if more children with MAM are enrolled and treated.
Keywords: community management of acute malnutrition, cost‐effectiveness, integrated community case
management, Kenya, moderate acute malnutrition.