A Systematic Review of the Economic Evaluation of Community-Based Management of Severe Acute Malnutrition Using Locally-Sourced Ready-to-Use Therapeutic Food in Niger: An African Perspective, 2021–2026

This systematic review synthesises economic evidence on the community-based management of severe acute malnutrition (CMAM) using locally-sourced ready-to-use therapeutic food (RUTF) in Niger. It aims to consolidate findings on cost-effectiveness, cost-benefit, and fiscal implications to inform policy. The review was conducted according to a pre-registered protocol and PRISMA guidelines. A comprehensive search of five electronic databases (PubMed, Scopus, EconLit, AJOL, and Global Health) and grey literature sources was performed for studies published from 2011 to 2023, using transparent search strings and pre-defined inclusion criteria. Identified records underwent rigorous dual screening, data extraction, and quality assessment using a standardised tool. The final synthesis included seven economic evaluations. Findings indicate that local RUTF production, utilising Nigerien crops, is a cost-effective alternative to imported products, with demonstrated reductions in ingredient costs and positive spill-over effects for local agriculture. However, evidence on long-term fiscal sustainability within the national health system is limited. Critical barriers identified include initial capital investment, consistent quality assurance, and supply chain logistics. This review concludes that investing in local RUTF production constitutes both a public health intervention and a strategic economic undertaking, with potential to improve health security, reduce import dependency, and stimulate local economies. It provides crucial evidence for policymakers in Niger and the wider Sahel region advocating for integrated health and economic strategies.