Community-based management of severe wasting (CMSW) programs have solely focused on exit outcome indicators, often omitting data on nutrition emergency preparedness and scalability. This study aimed to document good practices and generate evidence on the effectiveness and scalability of CMSW programs to guide future nutrition interventions in South Sudan. A total of 69 CMSW program implementation documents and policies were authenticated and retained for analysis, complemented with the analyses of aggregated secondary data obtained over five (2016–2020 for CMSW program performance) to six (wasting prevention) years (2014–2019). Findings suggest a strong and harmonised coordination of CMSW program implementation, facilitated timely and with quality care through an integrated and harmonised multi-agency and multidisciplinary approach. There were challenges to the institutionalisation and ownership of CMSW programs: a weak health system, fragile health budget that relied on external assistance, and limited opportunities for competency-based learning and knowledge transfer. Between 2014 and 2019, the prevalence of wasting fluctuated according to the agricultural cycle and remained above the emergency threshold of 15% during the July to August lean season. However, during the same period, under-five and crude mortality rates (10,000/day) declined respectively from 1.17 (95% confidence interval (CI): 0.91, 1.43) and 1.00 (95% CI: 0.75, 1.25) to 0.57 (95% CI: 0.38, 0.76) and 0.55 (95% CI: 0.39, 0.70). Both indicators remained below the emergency thresholds, hence suggesting that the emergency response was under control. Over a five-year period (2016–2020), a total of 1,105,546 children (52% girls, 48% boys) were admitted to CMSW programs. The five-year pooled performance indicators (mean [standard deviations]) was 86.4 (18.9%) for recovery, 2.1 (7.8%) for deaths, 5.2 (10.3%) for defaulting, 1.7 (5.7%) for non-recovery, 4.6 (13.5%) for medical transfers, 2.2 (4.7%) for relapse, 3.3 (15.0) g/kg/day for weight gain velocity, and 6.7 (3.7) weeks for the length of stay in the program. In conclusion, all key performance indicators, except the weight gain velocity, met or exceeded the Humanitarian Charter and Minimum Standards in Humanitarian Response. Our findings demonstrate the possibility of implementing robust and resilient CMSAM programs in protracted conflict environments, informed by global guidelines and protocols. They also depict challenges to institutionalisation and ownership.

Background: Globally, acute malnutrition remains a significant public health challenge. Severe acute malnutrition (SAM) is the most lethal type of acute malnutrition. This study aimed to produce pooled estimates of the effectiveness of integrated management of acute malnutrition (IMAM) programs in addressing SAM in Somalia. Methods: Medline, Embase, Cochrane, Web of Science, CINAHL, ProQuest, Google Scholar, eLENA, and the UNICEF website were searched with no language or date restrictions. Random effect models were used to estimate the pooled estimates of outpatient therapeutic program (OTP) and stabilization centres (SC) performance outcomes (I² > 50%). Results: Of 186 identified studies, three included data from IMAM programs in Somalia but were excluded, as they had incomplete data. Included were seven datasets identified through the authors’ list, which screened 36.34 million and admitted 2.31 million (6.35%) children aged 6–59 months. The pooled estimates of IMAM performance outcomes [%, (95% confidence interval)] for OTPs and SCs were, respectively, 2.45 (2.18, 2.56) and 4.11 (95%CI: 3.33, 4.90) for relapse, 95.39 (94.87, 95.90) and 80.81 (79.25, 82.37) for recovery, 0.18 (0.15, 0.21) and 1.73 (1.51, 1.95) for death, 2.57 (2.34, 2.79) and 2.75 (2.37, 3.12) for defaulter, 1.86 (1.55, 2.17), and 0.84 (0.66, 1.02) for non-recovery. Conclusions: OTP and SC performance outcomes in Somalia exceeded the Sphere Minimum Standards and compare favourably with results from the region. The adaptation of IMAM programs to meet multiple challenges in Somalia, supported by well-designed, coordinated, standardized, integrated, and harmonized implementation plans, is a strength.