What We Do

Nutrition & Community-based Management of Acute Malnutrition


Food insecurity, inappropriate child care practices, and lack of access to health services, clean water and sanitation contribute to high rates of undernutrition. Undernutrition causes 45 percent of all deaths of children under the age of five, leading to more than three million deaths per year. 

Undernutrition is defined as insufficient food intake (hunger) and repeated infectious diseases. Undernutrition includes being underweight for one’s age, too short for one’s age (stunted), dangerously thin (wasted), and/or deficient in vitamins and minerals (micronutrient malnutrition).


Today, the international health community is employing a treatment method that has saved hundreds of thousands of children’s lives. In 2002, Concern Worldwide and Dr. Steve Collins, Director of Valid International, worked together to find a solution that brought treatment directly to children in their communities.  We worked together to develop and implement a radical, innovative approach to treating malnourished children  with nutritional and medical support  known as “Community-based Therapeutic Care” (also known as CTC, or more commonly today, CMAM)

CMAM involves training community health volunteers to identify severe acute malnutrition in villages before the onset of medical complications, and then treating children at home with ready-to-use therapeutic food, and bi-weekly consultations with  health staff, rather than with inpatient care in far-away health facilities.  Today, CTC/CMAM programs reach over 70 percent of malnourished children in need of treatment

The proving ground for Concern and Dr. Collins’ 2002 collaboration was Malawi, where we launched a pilot project in response to a nutrition emergency. By 2004, the pilot demonstrated excellent treatment outcomes, achieved wide coverage, received high acceptance from the community, and proved to be a cost-effective alternative solution for the treatment of severe acute malnutrition, now administered in homes rather than at  inpatient treatment centers. 


Concern and Valid shared their knowledge with other agencies.  Working closely with UNICEF and with funding from USAID’s FANTA project, they also published a CTC Field Manual and modules for practical training on CTC for implementers.

In 2007, the United Nations endorsed the Community-based Management of Acute Malnutrition (CMAM) as international best practice, a testament to the years of pioneering work by Concern and Valid, and other agencies who followed in their footsteps. On a global level, CMAM has been endorsed and is being implemented to varying degrees by Ministries of Health in more than 55 countries. 

Concern’s nutrition leadership now extends to the organization’s key role in the Thousand Days Campaign and the Scaling Up Nutrition (SUN) movement, a collaboration of civil society members and governments to promote international efforts ensuring commitment at all levels to focusing efforts on combating undernutrition for the first 1,000 days between pregnancy and a child’s second birthday. 


Concern works not only treats malnutrition through its CMAM programs, but also to prevent and address its underlying causes, which include food insecurity, inappropriate child caring practices, and lack of access to health services, clean water and sanitation. Our health and nutrition teams provide communities with improved access to basic health care services, behavior change activities, and education. Our water and sanitation programs work to improve access to clean water and support improved sanitation facilities and practices including hand-washing. Our livelihoods programs empower communities to generate new sources of income, increase food production, and manage their own resources and food supplies.

At present, Concern has CMAM programs in 22 countries. Our work involves implementing programs in countries where existing health systems are limited and under-resourced. Concern is also playing a lead role in building the capacity of Ministries of Health at national and local levels in many countries.

In Zambia, Concern's "RAIN" initiative aims to prevent malnutrition by providing vulnerable communities with agricultural training and working with the government to implement policies that will ensure that the impact is lasting.

In the densely populated, chronically impoverished urban slums of Kenya, Concern is working to determine and define the international indicators that signal a nutrition emergency in urban contexts.

In Uganda, Concern works to reduce food insecurity and prevent malnutrition for vulnerable households in the Karamoja region. Our activities focus on proper infant and young child feeding practices and providing for the nutritional needs of pregnant and breastfeeding women, as well as for children under the age of two years old.  

In 2012, Concern has successfully transferred full management of our groundbreaking CMAM services to the government of Malawi. As a result, 17 out of 29 districts now provide CMAM in at least 80 percent of their health facilities, and nationally, 502 out of 617 health facilities use our approach to treat children with acute malnutrition at the community level, rather than in central feeding centers. Learn more HERE