Introduction:
Treatment of children with acute malnutrition has been less effective because of barriers in continuing to access health facilities after initiating treatment. We evaluated the effectiveness of integrating treatment of acute malnutrition at home by community-health volunteers (CHVs) into the integrated community case management (iCCM) program in northern Kenya.

Methods:
We conducted a two-arm non-inferiority cluster-randomized controlled trial across 20 community health units (CHUs) in Loima and Isiolo sub-counties. Participants were children aged 6-59 months with uncomplicated acute malnutrition. In each sub-county, 10 CHUs were pair-matched and randomly assigned to the control or intervention group. In the intervention group, CHVs used simplified tools and protocols to identify and treat eligible children at home and provided the usual iCCM package. In the control group, CHVs provided the usual iCCM package only (screening and referral of the malnourished children to the health facilities). The primary outcome was recovery (MUAC ≥12.5 cm for two consecutive weeks).

Results:
Children in the intervention group were more likely to recover than those in the control group [73.3% vs. 50.3%; risk difference (RD) 23.1% (95% CI 11.7 to 34.6) and risk ratio (RR) 1.38 (95% CI 1.14 to 1.67)]. The probability of defaulting was lower in the intervention group than in the control group: RD -19.8% (95% CI -31.2 to -8.3) and RR 0.41 (95% CI 0.24 to 0.69). The intervention reduced the length of stay by about 12 days, although this was not statistically significant. Weight gain was significantly higher by about 1 g/kg/day in the intervention group than in the control group.

Conclusions:
Integrating the treatment of acute malnutrition by CHVs into the iCCM program led to better malnutrition treatment outcomes. There is a need to integrate acute malnutrition treatment in iCCM and review policies to allow CHVs to treat uncomplicated acute malnutrition.