In Partnership With: Dr. Caterina Alacevich Dr. Jared Gars, Dr. Sanjana Kattera, & The Agency Fund

18% of children enrolled in CMAM (Community Management of Acute Malnutrition) programs drop-out before they fully recover, leading to avoidable deaths. Evidence from other low-resource public health settings suggests that an automated messaging intervention could cost-effectively improve attendance and, thus, speed a child’s recovery.

Taimaka is testing the use of automated voice calls sent to caregivers to reduce dropout rates which can help a child recover more quickly, preventing long term damage to their neurodevelopment, immune systems, and educational potential as well. Because these calls are very cheap (roughly 5 cents per call), even small effect sizes could prove highly cost-effective.

Our study includes 1,000 caregivers and their children in our CMAM program, 500 of whom will be randomized to a treatment group, and 500 of whom will be assigned to a control group. This randomized control trial (RCT) will assess whether automated voice calls have a statistically significant impact on program attendance and dropout rates. These results will be used to evaluate the cost-effectiveness of this innovation.

Read more about this study here.

While ready-to-use therapeutic foods (RUTF) are required to treat cases of severe acute malnutrition (SAM), patients presenting with moderate acute malnutrition (MAM) can be successfully treated with cheaper and more readily available complementary food. This food can be produced using locally-available ingredients like soya beans, maize, and groundnut.

Tom Brown, a locally produced complementary food, could 1) allow MAM cases to be treated more cheaply 2) create a more sustainable supply chain for malnutrition treatment products and 3) contribute to the local agricultural sector.

To assess the feasibility of using Tom Brown for MAM treatment, Taimaka is running a feasibility trial in its CMAM program by using Tom Brown to treat cases of moderate acute malnutrition (MAM). To determine the effectiveness of Tom Brown in the treatment of MAM, Taimaka will compare its pilot recovery rates to internationally-recognized acute malnutrition recovery standards like the Sphere Humanitarian Standards and comparable programs in the region. If Tom Brown is as effective as comparable products like reduced-dose therapeutic foods or supplementary foods, it would be much more cost-effective and sustainable for program use.

Read more about this study here.

Global CMAM (Community Management of Acute Malnutrition) treatment guidelines call for an antibiotic called amoxicillin to be provided to children with severe acute malnutrition. However, recent research has indicated that amoxicillin has no effect on mortality rates during treatment. Taimaka is testing an alternative antibiotic, azithromycin, as a replacement for amoxicillin in CMAM treatment, as prior studies have shown that azithromycin significantly reduces mortality for children under the age of five. So far, studies have not assessed the use of azithromycin in CMAM.

Taimaka estimates that if azithromycin’s demonstrated reduction in all-cause mortality generalizes to CMAM treatment, it would increase the cost-effectiveness of a $1 million CMAM program conducted by a large-scale implementer from 9.6x cash transfers (as estimated by GiveWell) to 10.9x cash transfers.

Taimaka and its partnered research team are running a clinical trial with 600 children with severe acute malnutrition in Taimaka’s own CMAM program. 300 of these children will receive standard treatment – amoxicillin – and 300 will receive azithromycin. This study will evaluate whether azithromycin has a statistically significant effect on 1) mortality, 2) the development of other diseases (e.g., malaria) and 3) time to nutritional recovery.

Read more about this study here.

Many low-resource settings where CMAM programs are implemented lack a cadre of trained, professional healthcare workers who can manage outpatient cases of acute malnutrition, which require specialized care. A lack of training can impair the triage process and slow the referral of the sickest children to inpatient care, which can drive higher mortality rates.

Taimaka has built an in-house tech solution to improve the capacity of community health workers (CHWs) to care for outpatient cases of acute malnutrition and triage the sickest children for referral to inpatient care. Taimaka’s triaging app guides CHWs through each step of triaging and treating cases by providing them with counseling information to supplement their pre-existing expertise.

Taimaka’s digital case management app runs on smartphones used by triage officers at each facility. Based on the child’s anthropometrics (e.g., weight, height), demographic data, test results (e.g., malaria, HIV), and previous week’s data, Taimaka’s app helps the triage officers ask relevant questions to assess the child’s change in status and produces decisions for treatment (e.g., the dose of therapeutic food for that week, or whether the child should be given ACTs for malaria treatment). These decisions and process guides standardize a high quality of care for children in our CMAM program and provide us with over 300 data points on a child’s health over their time in the program which allows us to quickly identify cases that are falling behind and may need additional attention.

Taimaka’s app is currently in a proof of concept stage, where we are assessing the costs to developing and maintaining the app, and predicting its efficacy in improving the triage process.