# The Economic Implications of Relapse Among Children Recovered from Severe Acute Malnutrition: Results from a Multicountry Prospective Study in Mali, Somalia, and South Sudan

## TL;DR

This study finds that treating children who relapse into malnutrition after recovery is twice as costly as initial treatment, suggesting that preventing relapse could save significant resources in nutrition programs.

## Contribution

The first analysis to estimate the economic cost of retreating children who relapse into malnutrition within six months of recovery.

## Key findings

- The cost of treating relapse to SAM is, on average, twice as high as initial SAM recovery.
- Preventing relapse could save $2 to $45 per child across the studied countries.
- Relapse treatment costs are 1.7–2.2 times higher than initial recovery costs.

## Abstract

The community-based management of acute malnutrition (CMAM) is effective at recovering children from severe acute malnutrition (SAM) and saving lives. However, postdischarge, children may relapse to acute malnutrition (AM), thereby requiring retreatment.

This study aims to assess the economic implications of treating children who relapse to AM within 6 mo of recovering from initial treatment for uncomplicated SAM in CMAM programs.

This study was part of a multicountry prospective cohort study in which children aged 6–47 mo with uncomplicated SAM were followed for 6 mo after recovery in Mali, Somalia, and South Sudan (SSD). Institutional cost data were collected monthly through accounting records or key informant interviews, depending on data availability. Mean costs per treatment episode for each CMAM program component were calculated (initial SAM recovery, relapse to SAM treatment, relapse to moderate AM treatment; 2022 USD).

The cost per child of recovery in initial SAM treatment was $191, $92, and $178 in Mali, Somalia, and SSD, respectively. The cost per child who failed to sustain recovery and required treatment for relapse to SAM was 1.7–2.2 times higher than initial recovery, amounting to an additional $215, $64, and $215/child in Mali, Somalia, and SSD, respectively. Not having to retreat children would save per admitted child on mean $2 in Somalia, $26 in SSD, and $45 in Mali.

This is the first analysis to estimate the cost of retreating children who relapse to AM within 6 mo of recovering from SAM. Our findings show that the cost of treating relapse to SAM is, on mean, twice as high as the initial SAM recovery. Preventing relapse could free up significant resources. Amid reduced global assistance, these results highlight the economic rationale for improving the efficiency of global nutrition programs by reducing relapse rates and strengthening prevention strategies.