Modeling optimized treatment for acute malnutrition (OptiMA) for ALIMA


ALIMA is a humanitarian medical aid organization based in Dakar, Senegal dedicated to continuous quality improvement in medical care in humanitarian contexts. ALIMA carries out scientific research to improve access and outcomes in these settings and is working to build a culture of innovation in health care delivery. Since its creation in 2009, ALIMA has treated over 10 million people in 14 countries, and launched more than 30 research projects – notably on malnutrition, maternal and child health, malaria, Ebola, and COVID-19. ALIMA and its partners have undertaken several research studies evaluating costs, outcomes, and cost-effectiveness for innovative child health and nutrition service packages in Africa, aiming to build an evidence base with which to convince policy and decision makers in nutrition, health, and finance to begin scaling up these approaches.


To improve upon standard malnutrition treatment protocols, ALIMA has developed Optimizing Treatment for Acute Malnutrition (OptiMA). While current approaches designate severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) as two separate categories for diagnosis and treatment, OptiMA simplifies the treatment of acute malnutrition as a continuum condition under a single protocol. OptiMA also uses a simple screening method based on mid-upper arm circumference (MUAC) which can be carried out in a family-based setting at home, rather than the more complex algorithms employed for SAM and MAM case management. An operational pilot in Burkina Faso showed it is feasible to implement the simpler OptiMA protocol in an entire health district with outcomes meeting or exceeding Burkina Faso’s reference standards. ALIMA hypothesizes that switching to OptiMA would result in non-inferior outcomes for children enrolled in a randomized control trial and save costs due to its relative simplicity, but a comprehensive economic evaluation of the OptiMA approach has not yet been carried out.


Pharos is working with the Yale School of Public Health and the Harvard School of Public Health to test these hypotheses using data from two randomized control trials (RCTs) in Niger and the Democratic Republic of Congo (DRC) supplemented with data from operational pilot studies in Burkina Faso, Niger, and Mali. Pharos is estimating the comparative resource use from a health sector perspective, focusing on the cost of nutritional supplementation products, outpatient clinical care, hospitalizations, and supply chain management. The team is using decision-analytic modeling to estimate the expected health outcomes and costs of operating an acute malnutrition program at scale, comparing OptiMA and other simplified protocols with standard national protocols.

The three phases of the project include:

Phase 1 (January 2020 – March 2021): Conduct a cost analysis of the OptiMA program using existing data from operational pilot projects in Burkina Faso. The article “Utilization patterns, outcomes and costs of a simplified acute malnutrition treatment programme in Burkina Faso” was published in Maternal & Child Nutrition in December of 2021.

Phase 2 (March 2021 – December 2022): Design and use a model to estimate cost-effectiveness of OptiMA compared to standard care in the DRC RCT.

Phase 3 (December 2022 – February 2024): Develop an improved model and use it to compare the cost-effectiveness of OptiMA and other simplified treatment protocols (ComPAS) with standard care in the Niger RCT.


This analysis will assist in program and financial planning, fill a major gap in evidence by calculating the incremental cost-effectiveness of the OptiMA protocol compared to the existing standard, and quantify the number and proportion of additional cases of acute malnutrition that can be successfully treated with OptiMA under real-world resource constraints.

Status: Ongoing, January 2020 – February 2024

Team Members Involved: Robert Hecht, Stephen Resch, Ryoko Sato, Claire Young, Grace Chen, and Mila Dorji

For more information, contact Mila Dorji at [email protected].

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