Taimaka – Comprehensive Summary

Last updated: December, 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 through a method called community management of acute malnutrition (CMAM). This approach involves identifying severely underweight children and providing them with a nutrient-enriched peanut butter formula alongside basic medical care to prevent or treat infections. CMAM is widely regarded as the gold standard in low-resource settings.

Organisation

Founded in 2019, Taimaka is an impact-minded organisation which provides CMAM in northeastern Nigeria. Taimaka’s programme is well-run, with  a high recovery rate of 95%. Unlike many other charities targeting malnutrition, which are Big NGOs with multiple programmes of potentially varying cost-effectiveness, Taimaka only has 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 events¹ We 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 (ready-to-use therapeutic food, non-perishable food that is calorie and micronutrient rich) 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 overall per person effect is 6.5 WELLBYs after averaging across our three different analyses (giving each of these equal weight).

Cost

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

Cost-effectiveness

The cost-effectiveness of Taimaka is $15 per WELLBY. This means for every $1,000 donated, the organisation creates 66 WELLBYs.

This estimate ranges from $14-$17 per WELLBY (or 60 to 72 WELLBY created per $1,000) depending on the three aforementioned evidence sources. Note that we also discuss some potential life-extending benefits in our report.

Quality of evidence

Our quality of evidence assessment is stringent. We assess quality of evidence according to an adapted version of the ‘GRADE’ criteria, a widely-used and rigorous tool for assessing evidence quality across healthcare and research fields. The GRADE criteria for evidence quality are very stringent, so we expect very few interventions that we evaluate for wellbeing in LMICs (which tend to be less well-studied) will score more than ‘moderate’ on the quality of their evidence. Considering most decisions about charities are made with little-to-no evidence, this is a substantial improvement.

We characterise the evidence quality as low, 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 (i.e., community management of acute malnutrition). There are no RCTs of such intervention because it’s justifiably considered unethical to withhold food from acutely malnourished children to create control groups. Instead, 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 (30-60%) of the analyses we think are useful. We have spent about 270 hours on this analysis.

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, but we recognize 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.

Our reports so far

We have one shallow report on Taimaka so far.