Our Approach

Taimaka incubates research that can make malnutrition treatment better, cheaper, and simpler. By improving the way that treatment is delivered, we can help scarce resources reach more children. Each year, we:

• Treat thousands of children suffering from moderate and severe acute malnutrition in a community management of acute malnutrition (CMAM program). 

• Incubate 3-4 candidate innovations in our CMAM program alongside leading academics, with the goal of making malnutrition treatment better, cheaper, or simpler.

To incubate innovations, we select candidate interentions which could substantially lower the cost-per-life saved of malnutrition treatment, based on literature reviews, conversations with other implementers, and input from patients. We then test these innovations in our treatment program, generating crucial evidence to support their wider adoption. Following successful tests, we partner with large implementers to conduct pilots of our ideas in their own portfolios, paving the way for them to adopt these approaches, reduce costs, and treat more children. With follow-on advocacy, we then work to spread adopted innovations to as many additional implementers as possible.

We take this innovation-focused approach because of its potential for outsized impact: reducing the cost of treatment by 20% would allow an additional 1 million children annually to receive treatment. Given our low costs of developing innovations, this is an extremely high leverage approach to solving global malnutrition.

Innovations Portfolio

Leveraging Automated Phone Calls to Reduce Dropout Rates

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

Across CMAM programs globally, an average of 18% of patients drop out of programs before they have completed their course of treatment and fully recovered from malnutrition. In Nigeria, where Taimaka works, this dropout rate has historically been as high as 50% in past CMAM programs.

Children who enter CMAM programs are in critical condition. If caregivers do not come back weekly to receive doses of therapeutic food, medications, and have their child screened, the child is statistically significantly more likely to die than their peers who finish treatment.

We hypothesize that sending automated calls to caregivers once a week in advance of their appointment can help reduce dropout rates by providing reminders and information about their child’s health, and addressing popular misconceptions like the belief that a child no longer needs treatment when they begin to look healthier. Simple messages like – “Though your child may already look healthier, they must complete their full course of treatment to recover! We look forward to seeing you at your weekly appointment.” – for example, could help address common caregiver misconceptions that drive dropout rates. Because automated voice calls are very cheap, even small effects could be highly cost-effective.

We’re running a randomized control trial (RCT) to determine if these automated voice calls can 1) improve program attendance and 2) reduce dropout rates among children with acute malnutrition.

Read more about this study here.

Improving Child Health through Maternal Mental Health

In Partnership with Dr. Seollee Park and Dr. Shanthi Manian & the Center for Effective Global Action (CEGA)

Mothers of acutely malnourished children are significantly more likely to experience depression and anxiety than mothers of healthy children. As a part of our broader commitment to improving the cost-effectiveness of malnutrition treatment, we are evaluating whether integrating maternal mental health treatment within community management of acute malnutrition (CMAM) programs is a cost-effective way to improve: (1) the subjective wellbeing of caregivers suffering from common mental disorders (CMDs) and (2) the nutritional outcomes of their children.

In 2024, Taimaka will launch an randomized control trial (RCT) to rigorously evaluate whether a WHO-approved individual therapy program called Problem Management Plus (PM+) can improve these outcomes. Multiple studies have demonstrated PM+’s efficacy among distressed populations in Kenya and Nepal, but its effectiveness among caregivers of young children has not been explored.

Taimaka will pilot PM+ in its existing community-based management of acute malnutrition (CMAM) program with 1,000 caregiver-child dyads to assess improvements in caregiver mental health and their child’s nutritional health. 

We estimate that adding maternal mental health treatment to CMAM programs has a marginal cost-effectiveness of 42 times as cost-effective as cash transfers. We estimate the overall cost-effectiveness of combined CMAM/maternal mental health programming at 15 times as cost-effective as cash transfers.

Read more about this study here.

Treating Moderate Cases with Complementary Food

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 called Tom Brown. This food can be produced using locally-available ingredients like soya beans, maize, and groundnut. 

Taimaka will produce Tom Brown to treat all cases of MAM in our 2022 and 2023 programming.

Tom Brown is an attractive candidate for the treatment of MAM for several reasons: 

1. Cost-Effectiveness: In our program, Tom Brown is 3x cheaper than a dose of ready-to-use food for MAM cases. 

2. Local Agriculture: All ingredients needed for Tom Brown can be produced locally, by smallholder farmers. If all cases of MAM in the state we work in were treated with complementary food, rather than other products, an estimated $230,000 would be invested in local agriculture each year.

3. Community-Production: Because Tom Brown’s ingredients - maize, soya beans, and groundnut - are readily available, caregivers in Taimaka’s CMAM program are counseled on how to produce this nutritious, high-protein food for their child, even after the program’s conclusion.

Learn more about this study here.

Reducing Mortality with Azithromycin

Current CMAM (Community Management of Acute Malnutrition) treatment guidelines call for a routine antibiotic, amoxicillin, to be provided to all newly enrolled severe acute malnutrition (SAM) cases, but 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, as studies have shown that azithromycin greatly 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.

Azithromycin is an attractive candidate for testing for three reasons:

1. There’s a strong evidence base that azithromycin has a large impact on all-cause mortality in children.

2. Substituting azithromycin for amoxicillin is very easy to do.

3. Because azithromycin is about the same cost as amoxicillin, any reduction in patient mortality translates into a potentially significant increase in the cost-effectiveness of CMAM treatment.

We’re running a pilot designed to determine if azithromycin is better than amoxicillin when it comes to 1) reducing mortality, 2) reducing the development of other diseases, and 3) speeding time to nutritional recovery among SAM cases.

Digital Case Management

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.

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. 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.

Learn more about this study here.