ABCDEFGHIJKLMNOPQRSTUVWXYZ
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Lower boundUpper bound
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Global estimates
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Childrent who are malnourished during a year45,422,114208,941,724
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Childrent who are severely malnourished during a year13,558,84062,370,664
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Childrent who are moderately malnourished during a year31,863,274146,571,060
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Increased chance of death as a result of malnutrition2.27.4
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Sub-Saharan Africa
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Number malnourished children/year, SSA10,078,55746,361,362
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Number malnourished children/year, SSA, untreated6,719,03838,189,934
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Cost per malnourished child treated, SAM$117$805
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Cost per malnourished child treated, MAM$35$241
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Mortality rate among well-nourished children, SSA1.3%
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Expected untreated malnourished mortality rate - SAM, SSA9.5%
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Expected untreated malnourished mortality rate - MAM, SSA2.8%
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Recovery rate90.0%
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Cost per death averted, SAM, SSA$1,925$13,246
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Cost per death averted, MAM, SSA$2,614$17,984
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Financing gap for SAM, SSA$173,214,522$5,293,048,397
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Financing gap for MAM, SSA$183,326,634$7,612,231,373
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Financing gap for GAM, SSA$356,541,156$12,905,279,770
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Deaths averted, SAM, SSA89,971399,591
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Deaths averted, MAM, SSA70,136423,268
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Deaths averted, GAM, SSA160,107822,859
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Calculations
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Malnourished childrenSources
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U5 world population677,942,000"Population by Age Group - Both Sexes" spreadsheet, Index 15, 2020 population estimate for World, https://population.un.org/wpp/Download/Standard/Population/
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GAM prevalence6.70%https://data.unicef.org/resources/joint-child-malnutrition-estimates-interactive-dashboard-2021/
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SAM prevalence2%https://data.unicef.org/resources/joint-child-malnutrition-estimates-interactive-dashboard-2021/
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Children who are malnourished during a year, lower bound45,422,114
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Incidence correction factor3.6"Results. We estimated incidence correction factors from 352 sites in 20 countries. Estimates aggregated by country ranged from 1.3 (Nigeria) to 30.1 (Burundi). Excluding implausible values, the overall incidence correction factor was 3.6 (95% CI 3.4 to 3.9)."Barba, Huybregts, and Leroy 2020, http://dx.doi.org/10.1136/bmjgh-2020-004342
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Sub-Saharan Africa (SSA)
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U5 population170,823,000"Population by Age Group - Both Sexes" spreadsheet, Index 375, 2020 population estimate for Sub-Saharan Africa, https://population.un.org/wpp/Download/Standard/Population/
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Percent of children under 5 with wasting5.9%UNICEF, WHO, World Bank, "Levels and trends in child malnutrition," 2021, Pg. 14, "SDG Regions" section, "Sub-Saharan Africa" row, "% wasted (moderate and severe)" column, https://www.who.int/publications/i/item/9789240025257
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Severe wasting1.3%UNICEF, WHO, World Bank, "Levels and trends in child malnutrition," 2021, Pg. 14, "SDG Regions" section, "Sub-Saharan Africa" row, "% wasted (severe)" column, https://www.who.int/publications/i/item/9789240025257
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Moderate wasting4.6%Calculation
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Hazard ratio for SAM compared to well-nourished children11.63"Mortality HR for severe wasting was 11.63 (9.84, 13.76)." Olofin et al. 2013, https://doi.org/10.1371/journal.pone.0064636
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Hazard ratio for MAM compared to well-nourished children 3.38See Olofin et al. 2013, Table 3, "Weigh-for-Length Weight/Height Z Score" section, "-3 to <-2" row, https://doi.org/10.1371/journal.pone.0064636
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Hazard ratio for GAM compared to well-nourished children 5.20Calculation
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Adjustment0.64*Key Assumption*
Conceptually covers:
-Upward adjustments for likely treatment of at least some complicated SAM in 6 historical studies
-Upward adjustment for greater over time drops in mortality among non-malnourished compare to malnourished population
-Upward adjustment for likely missed cases of kwashiorkor (edema) in cohort studies (cross country average of ~6.6% of SAM cases with significant variation)
-Higher prevalence of edema (which is higher risk) in program countries ( than historical countries for which we have edema estimates (GW calculations, unpublished)
-Higher risk pool selecting into treatment in programs than in community sample
-Over-performing MoH programs being represented in the literature we use to estimate MoH-only recovery rates

Downward adjustment for confounding (i.e., factors that raise mortality risk and are associated with malnutrition, but not addressed by malnutrition treatment (e.g., geographic remoteness)
-Potential for lower HRs of malnutrition that could be calculated from two missing studies
-Deaths not truly averted due to relapse

Direction of bias due to geography in unclear. The Olofin et al. 2013 historical studies have high variation in study-specific SAM HRs, and simple averages suggest that Asian countries have higher SAM HRs than African countries. (GW calculations, unpublished). However, this is contrary to other literature suggesting lower mortality rates due to SAM in India, e.g., Prost et al. 2019 https://doi.org/10.1371/journal.pmed.1002934
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Hazard ratio for SAM compared to well-nourished children, adjusted7.4Calculation
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Hazard ratio for MAM compared to well-nourished children, adjusted2.2Calculation
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Hazard ratio for GAM compared to well-nourished children, adjusted3.3Calculation
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Malnourished children, SSA
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Lower boundUpper bound
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Number malnourished, SAM, SSA2,220,69910,215,215
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Number malnourished, MAM, SSA7,857,85836,146,147
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Number malnourished, GAM, SSA10,078,55746,361,362
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SSA, % SAM treated (input for lower bound)33.33%"Regionally, the treatment coverage (number of children treated / number of wasted children) is low. In 2018, 1 out of 3 wasted children at high risk of mortality was treated." https://www.unicef.org/wca/media/5686/file/Child-wasting-factsheet-east-africa.pdf
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Treated globally, SAM (input for higher bound)4,900,000"In 2019, an estimated 11 million children received treatment for wasting." Footnote 5, which follows, says, "Estimate based on UNICEF reported admissions of children with severe wasting and other forms of acute malnutrition into therapeutic treatment in 2019 (4.9 million children) and WFP Annual performance report, 2019 (to be published)." Global action plan on child wasting, Pg. 2, https://df47766c-80b6-4069-8423-f776ea0aa544.filesusr.com/ugd/92555b_316bf3c585d04b169b147999d83c49fa.pdf
"In 2020 about 5 million children with life-threatening wasting were treated worldwide annually, which means that only 1 out of 3 children in need had access to treatment" UNICEF, No time to waste, 2021, Pg. 6, https://www.unicef.org/media/109716/file/No%20time%20to%20waste.pdf
"Life threatening" means "severe": "Today, an estimated 45.4 million children under 5 suffer from wasting and 13.6 million (approximately one-third) of these children suffer from severe wasting, the most life-threatening form of child malnutrition." UNICEF, No time to waste, 2021, Pg. 4, https://www.unicef.org/media/109716/file/No%20time%20to%20waste.pdf
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Treated globally, MAM (input for higher bound)6,100,000See above. If 4.9 of 11 million children who received treatment suffered from severe malnutrition, then 6.1 million likely suffered from moderate malnutrition.
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SSA SAM admissions 20152,600,000"At the regional level, admission trends are highest in
the West and Central Africa region (1.75 million children
admitted in 2015) and the East and Southern Africa
region (0.86 million in 2015)." UNICEF, "NutriDash: Facts and Figures," 2017, Pg. 23, https://www.ign.org/document.cfm?page_id=142003392
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Global SAM admission 20153,500,000"3.5 million children were admitted to SAM treatment programmes in 2015" UNICEF, "NutriDash: Facts and Figures," 2017, Pg. 23, https://www.ign.org/document.cfm?page_id=142003392
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SSA as a % global SAM admission 20150.74Calculation
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Est. SSA SAM admissions 20193,640,000"In 2019, an estimated 11 million children received treatment for wasting." Footnote 5, which follows, says, "Estimate based on UNICEF reported admissions of children with severe wasting and other forms of acute malnutrition into therapeutic treatment in 2019 (4.9 million children) and WFP Annual performance report, 2019 (to be published)." Global action plan on child wasting, Pg. 2, https://df47766c-80b6-4069-8423-f776ea0aa544.filesusr.com/ugd/92555b_316bf3c585d04b169b147999d83c49fa.pdf
"In 2020 about 5 million children with life-threatening wasting were treated worldwide annually, which means that only 1 out of 3 children in need had access to treatment" UNICEF, No time to waste, 2021, Pg. 6, https://www.unicef.org/media/109716/file/No%20time%20to%20waste.pdf
"Life threatening" means "severe": "Today, an estimated 45.4 million children under 5 suffer from wasting and 13.6 million (approximately one-third) of these children suffer from severe wasting, the most life-threatening form of child malnutrition." UNICEF, No time to waste, 2021, Pg. 4, https://www.unicef.org/media/109716/file/No%20time%20to%20waste.pdf
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Est. SSA MAM admissions 20194,531,429"In 2019, an estimated 11 million children received treatment for wasting." Footnote 5, which follows, says, "Estimate based on UNICEF reported admissions of children with severe wasting and other forms of acute malnutrition into therapeutic treatment in 2019 (4.9 million children) and WFP Annual performance report, 2019 (to be published)." Global action plan on child wasting, Pg. 2, https://df47766c-80b6-4069-8423-f776ea0aa544.filesusr.com/ugd/92555b_316bf3c585d04b169b147999d83c49fa.pdf
"In 2020 about 5 million children with life-threatening wasting were treated worldwide annually, which means that only 1 out of 3 children in need had access to treatment" UNICEF, No time to waste, 2021, Pg. 6, https://www.unicef.org/media/109716/file/No%20time%20to%20waste.pdf
"Life threatening" means "severe": "Today, an estimated 45.4 million children under 5 suffer from wasting and 13.6 million (approximately one-third) of these children suffer from severe wasting, the most life-threatening form of child malnutrition." UNICEF, No time to waste, 2021, Pg. 4, https://www.unicef.org/media/109716/file/No%20time%20to%20waste.pdf
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Lower boundUpper bound
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Number malnourished, currently untreated, SAM, SSA1,480,4666,575,215
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Number malnourished, currently untreated, MAM, SSA5,238,57231,614,718
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Number malnourished, currently untreated, GAM, SSA6,719,03838,189,934
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Cost of treatment
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Lower bound in cost from literature search, SAM, SSA$117Source: https://docs.google.com/spreadsheets/d/1w3H6-gIGxzdgYn_Ro5q6IDFYUNz29GtRQIAQrUBEy6s/edit?usp=sharinghttps://docs.google.com/spreadsheets/d/1w3H6-gIGxzdgYn_Ro5q6IDFYUNz29GtRQIAQrUBEy6s/edit?usp=sharing
Note that the estimates we use include inpatient costs in some cases, but not others: e.g., Isanaka et al. 2017: "We present an updated cost analysis to provide new estimates of the cost of providing community‐based treatment for severe acute malnutrition, including expenditure shares for major cost categories. We calculated total and per child costs from a provider perspective. We categorized costs into three main activities (outpatient treatment, inpatient treatment, and management/administration)"
Bailey et al. 2020: "Children exhibiting signs of a severe illness or danger sign according to the Integrated Management of Childhood Illness (IMCI) algorithm, or not passing the appetite test (consumption of 30 g of RUTF within 20 minutes), were excluded and referred for further assessment and care at an inpatient stabilization center or hospital."
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Upper bound in cost from literature search, SAM, SSA$805See above
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MAM cost, as a % of SAM30%https://docs.google.com/spreadsheets/d/1IdZLSBgEK46vc7cX9C7KnFgUcOk_M0UIYJ8go_DrvS0/edit#gid=1468241237&range=A161:B164
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Lower bound, MAM, SSA$35Calculation
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Upper bound, MAM, SSA$241Calculation
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Mortality rates
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Mortality rate among well-nourished children, SSA1.3%GW calculations, unpublished
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Expected untreated malnourished mortality rate - SAM, SSA9.5%GW calculations, unpublished
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Expected untreated malnourished mortality rate - MAM, SSA2.8%GW calculations, unpublished
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Recovery rate90.0%GW calculations, unpublished
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Malnutrition CE range, in x-cash
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development effects as a % total benefits6.89%GW calculations, unpublished
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Value of averting death of a malnourished child112GW calculations, unpublished
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Units of value per child treated, SAM, SSA6.88Calculation
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Units of value per child treated, MAM, SSA1.5684Calculation
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GD value/$0.0034https://docs.google.com/spreadsheets/d/1B1fODKVbnGP4fejsZCVNvBm5zvI1jC7DhkaJpFk6zfo/edit#gid=1680005064
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Malnutrition value/$, SAM, SSA0.05880.0085Calculation
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Malnutrition value/$, MAM, SSA0.04480.0065Calculation
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CE, multiples of cash, SAM, SSA172Calculation
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CE, multiples of cash, MAM, SSA132Calculation
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