Peer-reviewed article
Beyond therapeutic feeding: a call for integrated strategies to end child malnutrition in Somalia
Abdifatah Mohamed Tahlil, Mohamed Jama Hashi, Hafsa Mohamed Hassan, Mukhtar Baryare Matan, Abdifatah Hassan Elmi et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This paper argues that Somalia's long-standing reliance on community-based management of acute malnutrition (CMAM) treats the symptoms of child malnutrition but not its causes. It brings together recent survey, programme-evaluation and administrative data to show that the burden of acute malnutrition remains high despite treatment scale-up. The authors call for a shift toward integrated, multisectoral strategies that pair therapeutic feeding with water and sanitation, maternal and infant feeding support, primary health care, climate-resilient livelihoods and social protection. They propose four policy shifts and say these will need governance reforms and multi-year donor commitment.
Key points
- About 1.7–1.85 million children under five are estimated to have acute malnutrition each year in 2022–2025, including roughly 421,000–513,550 with severe acute malnutrition.
- CMAM meets international cure-rate standards but cannot address food insecurity, WASH, infectious disease, health-system and climate drivers.
- Stunting fell by only 9.7 percentage points over 24 years.
- Relapse after discharge is a documented challenge, and nationally representative estimates of CMAM treatment coverage are unavailable.
- Diagnostic discordance between screening tools leaves an unknown share of wasted children undetected, and sex- and region-based disparities persist.
Limitations
This is a policy-oriented synthesis of existing data, not a study testing an intervention, so it cannot show that the proposed integrated strategies work. The abstract also notes that national CMAM coverage estimates for Somalia are missing, which limits the picture of treatment reach.
Abstract
Somalia records one of the highest global burdens of child wasting and stunting, with approximately 1.7–1.85 million children under five estimated to be affected by acute malnutrition annually during 2022–2025, including approximately 421,000–513,550 children with severe acute malnutrition. For over two decades, the dominant policy response has been community-based management of acute malnutrition (CMAM), a curative intervention that treats clinical endpoints rather than underlying drivers. Despite meeting international cure-rate standards, CMAM alone cannot address the food insecurity, water, sanitation and hygiene (WASH), microbial and parasitic infectious diseases, health-system, and climatic drivers that perpetuate malnutrition. This paper integrates recent Somali survey, programme-evaluation, and administrative data to show that the national burden of acute malnutrition has remained high despite continued treatment scale-up, with stunting falling only 9.7 percentage points over 24 years, relapse after discharge remaining a documented challenge, and nationally representative Somalia-specific estimates of CMAM treatment coverage remaining unavailable. Diagnostic discordance between screening tools leaves an unknown share of wasted children undetected, and persistent sex- and region-based disparities highlight structural gaps. Ending child malnutrition in Somalia requires rebalancing investment from an emergency, treatment-centred paradigm toward integrated, multisectoral strategies combining therapeutic feeding with WASH investment, maternal and infant feeding support, primary health-care strengthening, climate-resilient livelihoods, and shock-responsive social protection. We propose four policy shifts: sustaining CMAM while addressing diagnostic gaps, mandating nutrition-sensitive financing, institutionalizing relapse prevention, and expanding anticipatory financing. These shifts require governance reforms and multi-year donor commitment to address the determinants of child nutrition in Somalia comprehensively.