When the COVID-19 pandemic hit the global stage, the world saw just how quickly the health and science communities could mobilize. But most global health crises do not attract the attention or resources of COVID-19.
We need to respond with the same level of solidarity and care in the fight against hunger. The situation is dire. The United Nations’ 2022 State of Food Security and Nutrition in the World report recently revealed that as many as 828 million people lived with hunger in 2021 — an increase of 150 million people from 2019.
Acute malnutrition — from moderate to severe — impacts 45 million children under the age of 5 worldwide. Despite the magnitude of this emergency, only less than 20% of these cases are treated. Among those who can access treatment, many will be diagnosed too late and treated with a protocol that is difficult for health workers to apply. We can do better than this.
The OptiMA protocol — short for Optimizing treatment for Acute Malnutrition — can inform a path forward. Developed by ALIMA, also known as the Alliance for International Medical Action, in close collaboration with the French National Institute of Health and Medical Research, OptiMA offers health workers a single program for the management of both severe and moderate acute malnutrition and uses a single ready-to-use therapeutic food, or RUTF, at a decreasing dose as the child improves. These important simplifications to the standard protocol carry the potential to shape the future of how we diagnose and treat children with acute malnutrition.
In April, results from an OptiMA randomized controlled trial were published in The Lancet Global Health, showing the effectiveness of OptiMA in a remote, post-conflict area of the Democratic Republic of Congo. This study shows hope for a future where more children could receive timely treatment for acute malnutrition, thus preventing the severest form of this condition.
The study found that OptiMA resulted in better outcomes than the current standard protocol for children with acute malnutrition in terms of weight and mid-upper arm circumference, or MUAC, gain over six months while using less RUTF per child. The data suggests that many more children could be treated with OptiMA using the same amount of funds spent now without compromising quality of care.
This offers hope to resource-strapped countries in sub-Saharan Africa and beyond, especially as we see food and supply costs skyrocket following Russia’s invasion of Ukraine.
The potential for OptiMA
OptiMA combines multiple innovations. First, it accelerates diagnosis by empowering parents — usually mothers — to detect wasting in their children in the home using a MUAC bracelet — a simple upper arm measurement tool. This leads to children being identified for treatment sooner. Reducing the complexity of care protocols in this way also takes the pressure off overburdened health centers and workers, potentially decreasing logistical costs of care and allowing caregivers to treat more children.
Second, OptiMA flips the standard treatment protocol on its head. Currently, two separate treatments that use two different nutritional supplements are used for children depending on the severity of their malnutrition. OptiMA integrates these therapies into one protocol using one nutritional supplement. Standard treatments increase the amount of RUTF prescribed over the course of a child’s treatment as their weight rises. OptiMA does the opposite: It tapers the dosage as the child's nutritional status improves, thus using less total RUTF per child. This means more children can be treated using the same amount of RUTF being used now.
Efficient use of RUTF is crucial during a time when production of this lifesaving product is failing to keep up with high demand. This is where simplified programs such as OptiMA can help: one streamlined protocol, nutritional product, and intergovernmental agency responsible for oversight.
UNICEF currently procures nearly 80% of all RUTF purchased and is thus the logical agency to fill this oversight role. Another critical player with the power to widen OptiMA’s reach is the World Health Organization, whose endorsement of the reduced RUTF dosage would encourage ministries of health to implement simplified protocols.
The path forward
ALIMA and its partners are running observational studies of the OptiMA protocol in Mali and Chad to document results in urban and rural settings. A second randomized controlled trial will soon be completed in Niger to determine whether the benefits of the new protocol seen in DRC are replicated in a Sahelian context.
Although initial results are encouraging, many research questions remain, particularly as pertains to optimum thresholds for determining program admission and discharge and the many challenges related to implementation at scale.
ALIMA is working with the International Rescue Committee, Action Against Hunger, and UNICEF, as well as directors of nutrition in ministries of health in West and Central Africa to share evidence and practical experience gained with other simplified protocols.
About the authors
Dr. Moumouni Kinda
Dr. Moumouni Kinda is ALIMA’s chief executive officer. He joined ALIMA in 2012 as medical coordinator and then was promoted to roles such as head of mission, medical desk supervisor, program manager and director of operations. Prior to ALIMA, he was part of several medical operations in Haiti, Chad, and the Democratic Republic of Congo for Médecins Sans Frontières.
Dr. Susan Shepherd
Dr. Susan Shepherd is a senior adviser for ALIMA’s pediatrics and research programs. A licensed pediatrician, she joined ALIMA in 2013 to develop new strategies for the care of malnourished children. A specialist in child malnutrition for more than 10 years, she has also worked with the World Food Programme and Médecins Sans Frontières in many countries in sub-Saharan Africa.
