The impact of a continuum of care intervention from prevention to treatment on child wasting compared with usual community group activities: a cluster-randomized controlled trial in Mali.
Huybregts L, Diop L, et al. • The American journal of clinical nutrition • 2026
Strengthening the continuum of care of wasting through community groups reduced the incidence of wasting and SAM and improved screening coverage, which translated into a modest gain in SAM treatment coverage.
Key Findings
Results
The intervention did not significantly impact wasting prevalence despite multiple components targeting prevention and treatment.
Primary outcome was wasting prevalence assessed in a longitudinal study of children enrolled at 6 months (n = 2324) with monthly follow-up for 3-6 months
Both arms included nutrition activity support groups (NASG) that screened children for wasting and provided caregiver behavior change communication (BCC)
The intervention arm additionally received small-quantity lipid-based nutrient supplements (SQ-LNS), child-centered BCC, family-led screening, and follow-up on referred wasting cases
No statistically significant difference in wasting prevalence was found between intervention and control arms
Results
The intervention reduced the incidence of wasting among children 6-23 months of age.
Relative risk of wasting incidence was 0.80 (95% CI: 0.64, 0.99) in the intervention arm compared to control
This represents a 20% reduction in wasting incidence
The finding was statistically significant as the confidence interval excludes 1.0
The study used a cluster-randomized controlled trial design with 2-arm allocation
Results
The intervention significantly reduced the incidence of severe acute malnutrition (SAM).
Relative risk for SAM incidence was 0.71 (95% CI: 0.57, 0.89), representing a 29% reduction
The confidence interval excludes 1.0, indicating statistical significance
SAM incidence was assessed in the longitudinal cohort of children enrolled at 6 months (n = 2324)
This was a stronger effect than observed for overall wasting incidence (RR 0.80)
Results
The intervention substantially increased wasting screening coverage.
Wasting screening coverage increased by 37 percentage points (pp) in the intervention arm (95% CI: 31, 44)
This was among the largest measured impacts of the intervention
Coverage surveys were conducted at the end of the study to assess this outcome
Family-led screening was one of the additional components provided to the intervention arm
Results
The intervention modestly increased SAM treatment coverage.
SAM treatment coverage increased by 15 percentage points (95% CI: 0.35, 30) in the intervention arm
The confidence interval barely excludes zero, indicating borderline statistical significance
The gain in treatment coverage was described as 'modest' relative to the larger gain in screening coverage
Additional OTP coverage surveys were conducted at the end of the study to measure this outcome
Results
The intervention had no significant impact on outpatient therapeutic program (OTP) recovery rates or treatment adherence.
A longitudinal study of all children 6-23 months admitted to OTP (n = 7104) was used to assess recovery and adherence
No statistically significant impacts on OTP recovery or adherence were found in either arm
This null finding occurred despite intervention components specifically designed to support OTP admission and adherence
Follow-up on referred wasting cases was included in the intervention to support OTP admission and adherence
Results
NASGs frequently deviated from the intended intervention protocol in two key ways.
NASGs often replaced the monthly home visits with community gatherings to deliver the intervention, deviating from the home-visit design
NASGs also frequently distributed SQ-LNS directly to children they identified with wasting instead of referring them to the OTP as intended
These deviations may help explain the null finding on OTP recovery and adherence despite improvements in screening and incidence
These implementation fidelity issues were noted as important contextual findings
Methods
The trial used a two-design approach to simultaneously evaluate both impact and pathways of the continuum of care intervention.
Design 1: a longitudinal study of children enrolled at 6 months (n = 2324) with monthly follow-up for 3-6 months to assess wasting prevalence (primary outcome)
Design 2: a longitudinal study of all children 6-23 months admitted to OTP (n = 7104) assessing recovery and adherence
Additional OTP coverage surveys were conducted at end of study
The trial was registered at clinicaltrials.gov as NCT04872088 and conducted in Mali
Control arm NASGs screened children for wasting and provided caregiver BCC; intervention arm received additional SQ-LNS, child-centered BCC, family-led screening, and referral follow-up
What This Means
This research tested whether strengthening community-based care for child malnutrition in Mali — from prevention through treatment — could reduce wasting (a dangerous form of malnutrition where children are too thin for their height) compared to standard community nutrition activities. The study enrolled over 2,300 young children in a randomized trial, tracking them monthly, and also monitored more than 7,000 children receiving treatment for severe malnutrition. The enhanced intervention added nutritional supplements (small-quantity lipid-based nutrient supplements, or SQ-LNS), extra education for families, community-led screening, and support to ensure children with malnutrition actually entered and completed treatment programs.
The study found that while the overall rate of wasting at any given time did not change significantly, the intervention did reduce the chances of a child developing wasting by 20% and severe acute malnutrition by 29%. It also dramatically improved screening — 37 percentage points more children were screened for malnutrition — and modestly improved the proportion of severely malnourished children who actually received treatment (by about 15 percentage points). However, once children were enrolled in treatment programs, their recovery rates and how well they stuck with the program were not improved by the intervention. Importantly, community health workers often changed how they delivered the program — holding group meetings instead of home visits, and giving nutritional supplements directly to malnourished children rather than referring them to formal treatment programs as intended.
This research suggests that community-based approaches can meaningfully reduce how often young children develop malnutrition and can bring more children into screening and treatment — but translating better screening into better treatment outcomes remains challenging. The finding that community workers adapted the program in unintended ways highlights how real-world implementation can differ from study design, and that future programs may need stronger support and supervision to ensure intended protocols are followed, particularly around referral pathways to formal treatment.
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Huybregts L, Diop L, Fall T, Barba F, Brander R, Toure M, et al.. (2026). The impact of a continuum of care intervention from prevention to treatment on child wasting compared with usual community group activities: a cluster-randomized controlled trial in Mali.. The American journal of clinical nutrition. https://doi.org/10.1016/j.ajcnut.2026.101294