Evaluating a Community-Based Management Programme for Severe Acute Malnutrition Using Ready-to-Use Therapeutic Food in the Lake Chad Basin, 2006

Severe acute malnutrition remains a critical public health challenge in the Sahel, exacerbated in crisis-affected areas such as the Lake Chad Basin. Facility-based treatment often suffers from low coverage and accessibility, highlighting the need for alternative approaches. This study evaluated a community-based management programme for severe acute malnutrition using ready-to-use therapeutic food in the Lake Chad Basin region of Chad. Its primary objective was to assess programme outcomes, specifically recovery, default, and mortality rates. A retrospective cohort analysis was conducted using routine programme data for children aged 6-59 months admitted for treatment across multiple community-based sites. Treatment protocols adhered to national guidelines, with outcomes defined by standard anthropometric and clinical criteria. The programme achieved a recovery rate of 78.4%. The default rate was 15.1%, and the mortality rate was 2.3%, meeting international Sphere standards. Key operational challenges included stock ruptures of therapeutic food and difficulties in following up defaulting children within highly mobile pastoralist communities. Community-based management of severe acute malnutrition using ready-to-use therapeutic food is a feasible and effective strategy in the complex, resource-limited context of the Lake Chad Basin. It can achieve satisfactory treatment outcomes when supported by robust logistical supply chains. Programme effectiveness requires strengthened community health worker networks and more reliable therapeutic food supply chains to reduce defaults. Nutrition interventions should be integrated with other community-based health services. Context-specific strategies are needed to track and retain mobile populations in treatment programmes. severe acute malnutrition, community-based management, ready-to-use therapeutic food, Lake Chad Basin, programme evaluation, Chad This paper provides empirical evidence on the implementation and outcomes of a large-scale community-based malnutrition programme in a protracted crisis setting.