Wasting is a persistent public health problem affecting 45 million children under five years of age worldwide. Wasting is responsible for the deaths of 875,000 children under the age of five every year. Children who survive often suffer from long-term cognitive and physical disabilities UNICEF, the World Health Organization, and the World Bank 2021; Black et al. 2013). Member countries of the World Health Assembly (WHA) have agreed to reduce and maintain the prevalence of wasting to less than 5 percent by 2025. Most Sahelian countries are off track to meet the WHA targets and in Chad, the prevalence of wasting is still unacceptably high at 14 percent and shows large regional disparities (UNICEF, the World Health Organization, and the World Bank 2020). While both wasting prevention and treatment programs hold the potential to reduce child wasting, substantial synergies can be expected when prevention is integrated with screening, referral, and treatment services. Such integration should happen at the community level to maximize the accessibility of services for caregivers and their children.

The Transform Nutrition West Africa project is a regional platform that aims to improve and support policy and program decisions and actions to accelerate reductions in maternal and child undernutrition through an inclusive process of knowledge generation and mobilization. Recognizing that knowledge is derived from evidence and experience, TNWA takes a ‘knowledge for action’ approach. As such, TNWA focuses on strengthening the latter stages of the data value chain (namely analysis, translation, and dissemination for decision-making). Through a regional consultation with different stakeholders (researchers, NGOs, civil society, private sector, government, UN, donor agencies) from various sectors, key priorities for future action in the region were identified. These included capturing, documenting, and learning from implementation experiences, and accelerating equitable program coverage of mother, infant and young child interventions at scale. We apply evidence synthesis approaches (i.e., rapid reviews) to identify best practices on topics as prioritized by regional stakeholders. Previous topics include effectiveness and implementation experience of interventions to improve exclusive breastfeeding and early initiation of breastfeeding in low- and middle-income countries (LMICs), implementation tools for nutrition, and a landscape analysis of research on adolescent nutrition in the region. Through engagements with UNICEF, the Regional Nutrition Working Group (which is a collective of donors, INGO’s, researchers, development agencies that are active in nutrition in the region), and other stakeholders, the next topic identified as a key issue for the region was wasting among children under five years of age. The output of this rapid review will not only inform various stakeholders active in the region but will also support the Integrated Research on Acute Malnutrition in the Sahel project (IRAM). IRAM aims to generate evidence on wasting prevention and treatment interventions in four countries: Chad, Mauritania, Mali and Niger (multi-country partnership between UNICEF and IFPRI). Stakeholders (review users, such as implementers and researchers) will be involved throughout. They will be consulted to set and refine the review question, eligibility criteria, and the outcome of interest. Consultations will ensure that this rapid review is fit for purpose.

Wasting is a persistent public health problem affecting 45.4 million children under five years of age worldwide. Wasting is responsible for the deaths of 875,000 children under the age of five every year. Children who survive often suffer long-term damage to their cognitive and physical development. Member countries of the World Health Assembly (WHA) have agreed to reduce and maintain the prevalence of wasting to less than 5 percent by 2025. Despite the commitment to tackle wasting, however, only one country in West Africa is on course to meet the WHA target. In contrast, seven countries, including Mali, have made no progress or have a worsening situation. In Mali, estimates from 2020 show prevalence levels of 9.3 percent, with critical regional disparities. Existing programs that aim to prevent or treat child wasting exist but typically suffer from low coverage and tend to be poorly integrated. While both strengthened prevention and treatment of wasting hold the potential to impact child wasting, substantial synergies can be expected when prevention is integrated with screening, referral, and treatment services. Such integration should happen at the community level to maximize the accessibility of services for caregivers and their children. Since the introduction of Mali's national infant and young child feeding strategy in 2012 (Ministère de la Santé du Mali 2012), community care groups called Nutrition Action Support Groups (NASGs) have taken center stage in delivering preventive behavior change communication (BCC) on infant and young child feeding (IYCF) practices and child health. However, to leverage the impact of these efforts on child wasting, NASG services need to be extended to support existing community-based treatment services and to prevent any posttreatment relapse. Further evidence is needed on the coverage and quality of implementation of these community groups, as existing evidence is scarce.

Despite falling rates of poverty and child undernutrition in Africa over the last two decades, the absolute number of people living in poverty and the absolute number of undernourished children continue to rise due to population growth (Beegle et al., 2018; Black et al., 2013). Global evidence suggests that cash transfer programs can reduce poverty and food insecurity and can build resilience for the poor. When cash transfer programs are com-bined with nutrition interventions, they also have the potential to accelerate improvements in child nutrition, especially when targeted to the critical window of opportunity for nutrition, the first one thousand days of a child’s life (Ruel et al., 2013). In West Africa, many cash transfer programs are combined with accompanying measures such as promotion sessions that aim to improve knowledge and increase adoption of recommended behaviors—including those related to child nutrition (Beegle et al., 2018, see Box 1). However, the extent to which such multi-component programs lead to changes in behavior and improve-ments in outcomes related to children’s nutrition and health is still not well-understood.

This report presents findings from the impact evaluation of the Jigisémèjiri program at midline. It first provides background on the evaluation, including details on the program and interventions. It then relates first-order, second-order, and third-order outcomes of interest in a conceptual framework, which guides our analysis and structures the report. The report next describes the evaluation design, sampling, and data collection process. It then presents statistics on beneficiaries’ experience with the CTs and AM. Last, it uses the baseline and midline data, exploiting the randomized design, to estimate the impacts of the program on its beneficiary population at midline, distinguishing between household-level outcomes and child-level outcomes. Given that the baseline report showed that the randomization process was successful at creating similar groups for comparison for the impact evaluation with similar preprogram characteristics, the impacts at midline can be interpreted as truly caused by the program rather than simply correlated with its receipt.

The use of theories, models and evaluation frameworks to design and evaluate interventions has now taken center stage in implementation science. The RE-AIM framework is one of the most used frameworks to plan and evaluate the implementation of interventions. RE-AIM framework is not only useful for researchers but also allows program implementers to broaden and structure their analysis to strengthen program implementation, design a performant monitoring and evaluation framework or conduct implementation research. The framework’s key dimensions are reach and effectiveness (at an individual level), adoption and implementation (at actor, staff, system, or policy/other levels), and maintenance (both at individual and actor/staff/system/policy levels) (Box 1). The utilization of the RE-AIM framework is not limited to assessing if a program reaches satisfactory levels of each dimension, but also aims at understanding the barriers and facilitating factors of each dimension. Furthermore, it recommends identifying which subgroups of actors or settings demonstrate good or poor adoption and implementation and to assess which subgroups of program beneficiaries benefit most from good intervention reach and effectiveness. Whereas most experience with RE-AIM comes from public health and behavioral studies conducted in high-income countries, the framework has been increasingly used for programs and interventions implemented in low-and middle-income countries and in a variety of thematic fields. Furthermore, the framework has been extensively used to assess the implementation of interventions consisting of few components. For the assessment of multi-component interventions, one way of applying RE-AIM to is first decompose the multi-components intervention into single components or activities and evaluate every component separately. However, such complex interventions can consist of intervention components or services that are either sequenced, layered, or integrated which may require an extension of the existing RE-AIM framework to evaluate the interaction between intervention components or services. This technical brief provides an example on how RE-AIM was operationalized by the Integrated Research on Acute Malnutrition (IRAM) which assessed the implementation and impact of a complex intervention package. The IRAM intervention aimed at strengthening various services along the continuum of care of child wasting in Mali. IRAM defined the continuum of care of child wasting as a series of services offered by different providers at various levels of care (household, community, facility) that cover the prevention of wasting, the screening for wasting, the referral of cases to treatment services, the admission and treatment of cases, and the post-treatment follow-up and prevention of relapse. We first show how REAIM was applied on single IRAM intervention components and services. We then highlight a few limitations that we encountered with RE-AIM for a complex intervention package and propose how to extend RE-AIM for interventions or services that are sequenced, layered, or integrated.

• Family-led MUAC, where caregivers and other household members screen their own children regularly to detect child wasting early-on, is a promising strategy to boost screening coverage leading to more children with wasting to be referred and enrolled in available treatment services. • In settings with regular active screening for wasting by community care groups in Chad and Mali, family-led MUAC had limited reach and effectiveness, thus contributing few additional cases detected, referred, and enrolled in wasting treatment services. • The introduction of family-led MUAC remained below expectation because the anticipated monthly home visits (main delivery platform) represented too much of a workload for volunteers. Monthly group sessions can be a suitable platform to train households to apply family-led MUAC on the condition that the attending number of caregivers per session is capped to allow for a more individualized approach. • Less than half of the households disposing of MUAC tapes screened their children monthly. The main reason reported for non-adoption was lack of knowledge and confidence on how to conduct the measurements, which calls for better training of caregivers and more social support to conduct the measurements. • Both the inadequate introduction by community volunteers, as well as the poor adoption by households of family-led MUAC resulted in a low reach of monthly screening by households (up to 10% in Chad and up to 25% in Mali). • Caregivers were able to measure their children’s MUAC accurately, and caregiver knowledge of family-led MUAC was moderate (Mali) to very high (Chad). • The short duration of the IRAM program (7-9 months), due to the COVID-19 crisis, may have hampered a continuous learning process leading to improvement of family-led MUAC over time.

In rural West Africa, the rate of out-of-school children is high and delayed entry to primary school is common, particularly for girls. Using the randomized roll-out of an unconditional cash transfer program (Jigisemejiri) in Mali, we examine its impact on child schooling by age and sex. The program leads to significant improvements in schooling outcomes for girls, but not boys. Improvements among girls are especially salient among younger (ages 6–9) and older (ages 15–18) girls. Pathway analysis reveals that the program reduces the time younger girls spend in agricultural work at home and the time older girls spend in domestic work as well as self-employment. Households in the program also spend more on education for older girls in terms of school fees, materials, and transport.

n Afrique, malgré la baisse des taux de pauvreté et de sous-nutrition infantile au cours des deux dernières décennies, le nombre absolu de personnes vivant dans la pauvreté comme le nombre absolu d'enfants sous-nutris continuent d'augmenter en raison de la croissance démographique (Beegle et al., 2018 ; Black et al., 2013). Les données mondiales indiquent que les programmes de transferts monétaires peuvent réduire la pauvreté et l'insécurité alimentaire, et renforcer la résilience des pauvres. Lorsque les programmes de transferts monétaires sont combinés avec des interventions nutritionnelles, ils peu-vent également accélérer les améliorations en matière de nu-trition infantile, en particulier lorsqu'ils ciblent la période cruciale pour la nutrition que sont les 1000 premiers jours de la vie d'un enfant (Ruel et al., 2013). En Afrique de l'Ouest, de nombreux programmes de transferts monétaires sont associés à des me-sures d'accompagnement telles que des séances de sensibili-sation visant à améliorer les connaissances sur les comporte-ments recommandés et à en favoriser l'adoption, y compris ceux relatifs à la nutrition infantile (Beegle et al., 2018, voir En-cadré 1). La mesure dans laquelle ces programmes à compo-santes multiples entraînent des changements de comportement ainsi que des améliorations dans les résultats liés à la nutrition et à la santé des enfants n'est cependant pas encore bien appréhendée.