Taimaka – Comprehensive Summary

Last updated: November, 2024

Problem

Severe malnutrition isn’t history. It’s not relegated to disasters, famines, or warzones. It remains a large problem, faced by millions of children every year (45 million children in 2022, WHO, 2024).

Intervention

Acute malnutrition can be effectively treated by first identification extremely malnourished children (as being underweight) and feeding them a standardised formula of peanut butter enhanced with vitamins and nutrients alongside basic medical care to prevent or treat infection. This process is called community management of acute malnutrition (CMAM) and is the current gold standard of treatment, especially in low resource settings.

Organisation

Founded in 2019, Taimaka is an impact-minded organisation which provides community management of acute malnutrition in northeastern Nigeria. They only have one program and a small budget (in 2023 it was $328,231).

Evaluation

Methods

We estimate the benefit of CMAM using broader evidence about the effects of malnutrition and treating it (because there is no direct casual evidence). Specifically, we make four different estimates based on three different interventions or events¹We also considered using a fourth evidence source, a study that compared children who experienced acute malnutrition as a child in Barbados to healthy children (n = 129), but decided this was too speculative given that its small sample and that the design doesn’t afford a causal estimation of the effect of reducing malnutrition. However, we discuss it in Appendix B.:

• Using the very long-term wellbeing effects of an RCT (n = 1,249) of providing a protein and calorically rich supplement called Atole over three years compared to receiving a less nutritious supplement.

• Using seven studies of two natural experiments (n = 34,724) studying the very long-term wellbeing effect of famines in the Netherlands and China, and guessing at how much of the effects of famine were due to acute malnutrition versus other factors like chronic malnutrition, displacement or having family members die.

• Using an individual level meta-analysis of 13 RCTs (n = 23,588) of small quantity lipid-based nutrient supplements (SQ-LNS), a smaller dose version of RUTF meant to treat chronic malnutrition and prevent malnutrition in children aged 0.5 to 2 years. Here we attempt to translate the short term cognitive and socio-emotional benefits (measured at a few months to a few years after treatment) into later in life wellbeing benefits.

Impact

We estimate that the per person effect is 6.5 WELLBYs after averaging across our three different analyses.

Cost

Taimaka estimates they can treat a child with malnutrition in 2025 for ~$87.

Cost-effectiveness

We estimate Taimaka’s life-improving cost-effectiveness after discounts as 66 WELLBYs per $1,000 (WBp1k), ranging from 60 to 72, a cost of $14-17 per WELLBY or 8 to 10 times as good as GiveDirectly cash transfers²For GiveDirectly we estimated the cost-effectiveness at 7.55 WBp1k (i.e., $132 per WELLBY; McGuire et al., 2022a). GiveDirectly is an NGO which provides cash transfers to very poor households. We take cash transfers as a useful benchmark because they are a straightforward, plausibly cost-effective intervention with a solid evidence base. (For more detailed and updated charity comparisons, see our charity evaluations page.). The exact figure depends on which indirect evidence sources we extrapolate from: causal evidence of famine or two nutritional interventions related to RUTF.

Quality of evidence

We characterise the evidence quality as low quality or weak, and thus the analysis that’s based on it as speculative. This is particularly because the evidence is not directly relevant to the intervention Taimaka delivers (community management of acute malnutrition).

Instead, because it’s justifiably considered unethical to withhold food from acutely malnourished children to create control groups for RCTs, we had to use evidence from treatments of moderate malnutrition, famines, or a single RCT studying a protein rich supplement from the 1970s in Guatemala. This introduces considerable uncertainty into our analysis.

Depth of our analysis

We also rate the depth of work gone into creating this estimate as low. By this we mean that we believe we have only reviewed some of the relevant available evidence on the topic, and we have completed only some (10-60%) of the analyses we think are useful.

Funding need

They report being able to absorb up to $500k in 2025 as they grow their treatment program to reach 9,000 patients annually.

Conclusion

We estimate that Taimaka is cost-effective (66 WBp1k), but we recognise that our cost-effectiveness estimate is extremely speculative. We think CMAM may be cost-effective and that Taimaka could be a good funding opportunity despite the high levels of uncertainty in this CEA. Further research on the long-term wellbeing effects of malnutrition (or treating it) would also be quite valuable.