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Summary

Globally, 45 million children suffer from malnutrition, leading to 2.3 million child deaths annually. But even for those who live, the experience of malnutrition can have lifelong impacts on physical and cognitive health and social-emotional development.

There is a consensus on how best to address extreme malnutrition: feeding kids a standard formula of peanut butter enhanced with vitamins and nutrients alongside basic medical care to prevent or treat infections. This intervention, known as community management of acute malnutrition (CMAM), saves lives and improves health and development.

In this shallow report, we evaluate the cost-effectiveness of a CMAM programme in Nigeria delivered by the organisation Taimaka. To our knowledge, this is the first analysis of the impact of CMAM on long-term wellbeing. We also think this is the first wellbeing cost-effectiveness analysis of a nutrition charity (along with our analysis of Fortify Health).

This forms part of our broader work to assess the cost-effectiveness of interventions and charities based on their impact on subjective wellbeing, measured in terms of wellbeing-adjusted life years (WELLBYs). One WELLBY is equivalent to a 1-point increase on a 0-10 wellbeing scale for one person over one year. We focus on subjective wellbeing because we believe it best captures what ultimately matters, wellbeing. By using wellbeing as a common outcome, it allows us to make apples-to-apples comparisons between very different interventions.

There are no RCTs estimating the wellbeing effects of CMAM programmes, so we extrapolate the effect on long-term wellbeing using broader evidence about the effects of malnutrition and treating it. Specifically, we use three sources of evidence, to which we give equal weight in our analysis (i.e. 33% to each):

• One RCT on the impact of atole, a corn-based protein supplement (n = 1,249).

• A Meta-analysis of 13 RCTs on the impact of another nutritional supplement, small quantity lipid-based nutrient supplements (n = 23,588).

• Two natural experiments on the effects of scarring from famine (n = 34,724).

Based on this evidence, we estimate that CMAM programmes have a wellbeing effect of approximately between 0.09 to 0.46 standard deviations (SDs) per person that lasts 62 years. The naive total individual benefit is 3 to 15 WELLBYs with an assumed spillover effect of 16% WELLBYs for a total effect of 17 to 57 WELLBYs. However, we discount this by 91% to 51% (for a mix of replicability and generalizability concerns) to arrive at our final effect estimate of 5 to 6 WELLBYs.

Taimaka estimates they can treat a child with malnutrition in 2025 for ~$87. We estimate Taimaka’s life-improving cost-effectiveness (after discounts) as ranging from 60 to 72 WELLBYs per $1,000 (WBp1k) with a central estimate of 66 WBp1k. The cost is $15 per WELLBY, or in other terms 9 times as good as GiveDirectly cash transfers. The exact figure depends on which indirect evidence sources we extrapolate from: causal evidence of famine or two nutritional interventions related to RUTF.

Although we have some uncertainties in our analysis, we view Taimaka as a charity with promising cost–effectiveness. It also exhibits positive qualitative factors such as transparency and evidence-based decision-making. We compare Taimaka to other charities and discuss our current funding recommendations on our website. At the time of writing this, we believe Taimaka could absorb $500k in additional funding for 2025.

We also estimate that those who would place a high value on saving lives (having deprivationist beliefs) would attribute an additional 66 WBp1k to Taimaka.

We rate the depth of work supporting this estimate as low and the evidence quality is also as low (i.e., weak). For these reasons we view this analysis as speculative. The evidence quality is weak primarily because CMAM lacks direct causal evidence for its effects on any outcome. There are ethical issues with running a randomised controlled trial (RCT) where a control group of malnourished children isn’t fed.

We think the best way to improve the evidence base for the wellbeing effects of treating malnutrition is to add wellbeing outcomes to the follow-ups of RCTs of related treatments for milder forms of malnutrition. We discuss this and some further topics for research in Appendix E, at the end of this document.