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Summary

Children going hungry, being malnourished or, at worst, starving, doesn’t really require justification as a problem worth solving. Severe malnutrition is still a large problem, faced by 45 million children in 2022 (WHO, 2024). There is also a consensus on how best to address extreme malnutrition: by feeding kids a standardised formula of peanut butter enhanced with vitamins and nutrients alongside basic medical care to prevent or treat infections. This saves lives. However, this intervention, known as community management of acute malnutrition, hasn’t been evaluated from a wellbeing perspective – particularly the long-term consequence for wellbeing of avoiding the worst of an episode of acute malnutrition.

This report is part of our research to try and find the most cost-effective ways to increase global wellbeing. We believe this report, alongside our analysis of Fortify Health, is the first wellbeing cost-effectiveness analysis of a nutrition charity.

Why wellbeing? We evaluate charities with wellbeing-adjusted life years (WELLBYs). The metric is simple: one WELLBY is equivalent to a 1-point increase on a 0-10 life satisfaction scale for one year. WELLBYs allow us to impartially compare the impact of very different charities addressing very different problems, and while not without limitations, we think it is the best way (yet) of capturing what really matters. 

In this shallow report we perform a speculative wellbeing cost-effectiveness analysis of community management of acute malnutrition (CMAM) in Nigeria by Taimaka. CMAM treats cases of acute malnutrition in an outpatient setting with ready-to-use therapeutic foods (RUTF) to replenish energy and nutrients and by addressing complications (i.e., infections) related to malnutrition. It also provides inpatient care for complications (e.g., cases of severe malaria). 

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), a cost of $14-17 per WELLBY or 8 to 10 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. 

While uncertain, 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 whether we recommend it for funding 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 as also 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. 

Instead of relying on direct causal evidence, we have to extrapolate from other sources of evidence about the causal wellbeing effects of malnutrition. This extrapolation is made uncertain because the exact mechanism through which CMAM improves long-term wellbeing is unclear – beyond malnutrition generally damaging development. 

We think the best way to improve the evidence base for the wellbeing effects of treating malnutrition is to adding wellbeing outcomes to 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.