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Effectiveness of management of severe acute malnutrition (SAM) through community health workers as compared to a traditional facility-based model: a cluster randomized controlled trial



We compared the impact of management of severe acute malnutrition (SAM) by lady health workers (LHWs) at a community level with the standard CMAM program provided at the health facility.


A two-arm cluster randomised controlled trial was conducted in a rural district in sindh Pakistan. The primary outcome was recovery from SAM and secondary outcomes were relapse, defaulter and mortality rate.


A total of 829 children were recruited in the trial (430 in intervention and 399 in control groups). No significant difference was noted in recovery rate between the intervention and control groups (79.2% vs 85.6%, p = 0.276). Similarly, no significant differences were noted in relapse (p = 0.757), weight gain (p = 0.609), deaths (p = 0.775) and defaulter rate (p = 0.324) across the groups. Compliance of RUTF was significantly higher in the control group (93%) than in the intervention group (87%), p < 0.000.


Our results showed no impact of SAM treatment on performance indicators of CMAM (recovery, relapse, death and default) between the standard CMAM programme performed at the health facility by the government and NGO staff and the programme performed at health house level by the LHWs in Pakistan. We recommend further robust trials in other settings to confirm our results.

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We are thankful to the District and Provincial authorities of National Program for Family Planning & Primary Health Care, Lady Health Worker Program, Sindh, Pakistan for providing support to conduct this study


This study was supported by Innocent Foundation through Action against hunger (ACF) International.

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Authors and Affiliations



SBS conceived the idea and reviewed final manuscript. SC were involved in the field implementation of the trial. AR analysed the data. IH, AH and SA contributed in the development and revision of the manuscript. AH, SF, GNK, DK, JLA, SG and AG critically reviewed the manuscript. All authors reviewed and approved the manuscript.

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Correspondence to Sajid Bashir Soofi.

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This is an original study and has not been published elsewhere, and all authors have no conflict of interest related to the study.

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Hussain, I., Habib, A., Ariff, S. et al. Effectiveness of management of severe acute malnutrition (SAM) through community health workers as compared to a traditional facility-based model: a cluster randomized controlled trial. Eur J Nutr 60, 3853–3860 (2021).

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  • Severe acute malnutrition
  • LHWs
  • Community-based management
  • Health facility management
  • RUTF