Key components of cmam programs are provision of a therapeutic food that is of high nutritional quality and has minimal spoilage, known as readytouse therapeutic food rutf, and. Perspectives for integration into the local health system of communitybased. Globally, moderate acute malnutrition mam and severe acute malnutrition sam affect approximately 52 million children under five. Background acute malnutrition is a leading cause of morbidity and mortality in children aged under five years, especially in low and middle income countries lmics. However, current capacity in the province prevents us from implementing the programme as is, and thus a gradual development towards implementation of such a programme is proposed. Who library cataloguinginpublication data technical note. Supplementary foods for the management of moderate acute. Timor leste, moderate acute malnutrition treatment. Management of severe acute malnutrition according to who guidelines can reduce the casefatality rate by about 55% in hospital settings. G262p the management of moderate acute malnutrition in.
World vision uses the communitybased management of acute malnutrition cmam model to address this issue. It is a nutritional program designed especially for children of 659 months of age and is a very important concept for management of malnutrition. You also considered some of the most important methods and principles for managing moderate acute malnutrition mam. This technical brief is one of three commissioned by the communitybased management of acute malnutrition cmam forum. Fact sheet htp, version 2, 2011 1 the fact sheet is the first of four parts contained in this module. Considerations for scaling up production and use in programs saskia osendarp, beatrice rogers, kelsey ryan, mark manary, peter akomo, paluku bahwere, hilina belete, mamane zeilani, munirul islam. The smart method ensures consistent and reliable survey data to be collected and analyzed using single standardized methodology. Recognition and management of malnutrition 8 daniel martinezgarcia md laurent hiffler,md teresa m. Moderate acute malnutrition in children is defined as a weightforheight between 3 and.
In children aged 659 months, an arm circumference less than 110 mm is also indicative of severe acute malnutrition. Nutritionally designed specifically for the management of moderate acute malnutrition with the similar advantages to rutf plumpynut e. Field guide for management of moderate acute malnutrition somalia. Imam stands for integrated management of acute malnutrition it is an integrated program to fight back against acute malnutrition. If it goes untreated, it can lead to severe acute malnutrition. It is severe acute malnutrition if the wasting is severe wh 125 mm 70 and management of moderate acute malnutrition although the typology of interventions for mam and their indicated uses in different contexts have been topics of considerable discussion, substantial ambiguity remains in practice in the classification of interventions, and evidence gaps persist regarding the effectiveness of interventions. S60 s the development of specially formulated readytouse therapeutic foods rutfs has enabled treatment of severe acute malnutrition sam in. Severe acute malnutrition contributes to 1 million deaths among children annually. Undernutrition and severe acute malnutrition in children. Pdf management of moderate acute malnutrition with rutf in niger.
The user must also be aware that with the rapid changes in the field of nutrition in emergencies, due to increased new findings from research, this field guide will often be updated to reflect these changes. Management of severe acute malnutrition in children the. Dietary counselling, breastfeeding counselling, and positive feeding and caring practices should always be part of the management of moderate malnutrition, even when food supplements are given. Training guide for communitybased management of acute. Management of malnutrition in children under five years. Body mass index bmi bmi is the weight in kilograms divided by. Process for developing nutrition guidelines at who. While world vision seeks to prevent acute malnutrition through multisectoral community development and targeted nutrition interventions, acute malnutrition still persists in far too many communities around the world. Communitybased management of acute malnutrition cmam is a structured system of outpatient care for children with uncomplicated severe acute malnutrition sam. Smart is an improved survey method that balances simplicity for assessment of acute malnutrition and technical soundness. Worldwide there are about 60 million children with moderate acute and million with severe acute malnutrition.
The communitybased management of acute malnutrition cmam forum published a technical brief in 2014 that echoed the who guidelines and discussed. The dietary management of children with moderate acute malnutrition is based on the optimal use of locally available foods to improve nutritional status and prevent severe acute malnutrition. Community based management of acute malnutrition cmam communitybased management of acute malnutrition cmam is a decentralised communitybased approach to treating acute malnutrition. Supplementary foods for the management of moderate acute malnutrition in infants and children 659 months of age, world health organization, geneva 2012. This section is intended mainly for practitioners and program managers. Action against hunger tackles acute malnutrition and finds solutions to malnutrition using an integrated nutrition strategy.
It provides an overview of the management of moderate acute malnutrition mam in emergencies, with a focus on supple. In developing countries, it is estimated that 19 million children 3. Severe acute malnutrition is defined in these guidelines as the presence of oedema of both feet or severe wasting weightforheightlength acute malnutrition study session 10 managing severe acute malnutrition introduction. For effective use of this field guide, the users must be. Readytouse foods for management of moderate acute malnutrition. In situations of food shortage, or where some nutrients are not sufficiently available through local foods, supplementary foods have been used to treat. Lipid nutrient supplements have been proposed as a. Training the harmonised training package htp is a primarily a resource for trainers in the nutrition in emergencies nie sector and it can be used by individuals to increase their technical knowledge of the sector. Management of severe acute malnutrition in lowincome and middleincome countries.
The guide is an extract from the national guidelines for management of moderate acute malnutrition. Key messages of imam integrated management of acute. Acute malnutrition is classified into severe acute malnutrition1 sam and moderate acute malnutrition mam according to the degree of wasting and the presence of oedema. Cmam community based management of acute malnutrition. Assessment of coverage of communitybased management. Pdf management of moderate acute malnutrition with rutf. The dietary management of children with moderate acute malnutrition is based on the optimal use of locally available foods to improve nutritional status and prevent the condition from deteriorating to severe acute malnutrition. Locally produced readytouse supplementary food is an effective treatment of moderate acute malnutrition in an operational setting. Treatment is matched to the nutritional and clinical needs of the child, with the majority children receiving treatment at home using readytouse foods. Key priorities for enhancing effectiveness of severe acute malnutrition sam and moderate acute malnutrition mam management. Addressing acute malnutrition world vision international. Management of acute malnutrition in infants mami project 2. Management of uncomplicated severe acute malnutrition in. Federal bureau of prisons medical management of malnutrition undernutrition clinical guidance september 2014 1 1.
Research priorities for effective management of sam develop midupper arm circumference cutoffs specific to age. Analysis of results for 59,698 moderate malnourished children showed a cure rate of 95. Treatment of severe and moderate acute malnutrition in low. It covers management of severe malnutrition, with an inpatient outline based on who standards and updates from professor michael golden, and an outpatient outline based mainly on the communitybased. In the last session you learnt about the use of anthropometric indices to determine the nutritional status of women and children. Although the median underfive casefatality rate for severe acute malnutrition typically ranges from 30% to 50%, it can be reduced substantially when physiological and metabolic changes are taken into account. Report on communitybased management of acute malnutrition cmam in nepal and kenya for action against hunger, international medical corps and global health advocates. Management of severe and moderate acute malnutrition in children. Cmam forum 2014 managementcmamforumtechnicalbriefsept2014. Management of acute malnutrition in infants mami project. Management of moderate acute malnutrition with rutf in niger. Only foods and feeding practices that are affordable, feasible, and acceptable to families should be recommended. Malnutrition moderate acute malnutrition mam, severe acute malnutrition sam, and global acute malnutrition gam its risk factors and causes of undernutrition are discussed in this chapter, as well as the consequences of acute malnutrition. Training guide for communitybased management of acute malnutrition cmam, 2018 version this cmam training guide is designed for health care managers and providers who manage, supervise, and implement services for the management of acute malnutrition, including those involved in community outreach activities.
A proposed combined protocol to treat acute malnutrition provides for streamlined management of both severe and moderate forms in emergency settings. For communitybased management of acute malnutrition cmam1 or integrated management of acute malnutrition imam this will be the proportion of children with severe acute malnutrition sam who receive therapeutic care2. Background moderate acute malnutrition is a major public health problem affecting children from low and middleincome countries. Interventions to prevent and treat malnutrition 11. Early detection of severe acute malnutrition with and without medical complications and evidence based integrated management involving continuum of care will be key to the success of strategies for minimising the burden of severe acute malnutrition in. The brief focuses on current principles and approaches to moderate acute malnutrition mam management, highlighting key constraints, gaps in knowledge and areas still lacking consensus. Communitybased management of acute malnutrition cmam is. This approach combines the assessment of nutritional status of children, treatment of acute malnutrition, and prevention of all forms of malnutrition.
Subsequent chapters present the management of moderate acute malnutrition mam in supplementary feeding. Management of moderate acute malnutrition in children in resource. Considerations for scaling up production and use in programs. Severe acute malnutrition pocket book of hospital care. Moderate acute malnutrition mam, also known as wasting, is defined by a weightforheight indicator between 3 and 2 zscores standard deviations of the international standard or by a midupper arm circumference muac between 11 cm and 12. Valid nutrition has developed a readytouse supplementary food rusf, also called lipidbased nutrient supplement large quantity or lnslq to treat moderate acute malnutrition in children over 6 months and adults. Purpose and terminology the federal bureau of prisons bop clinical guidance for the medical management of malnutrition undernutrition provides recommendations for the assessment and nutritional augmentation of inmates who are in a. Moderate acute malnutrition mam in the context of cmam. Supplementary foods for the management of moderate acute malnutrition in children aged 659 months in children aged 659 months, moderate acute malnutrition is defined as moderate wasting i. Protocol for the management of severe acute malnutrition. Management of severe and moderate acute malnutrition in.
Defourny and others published management of moderate acute malnutrition with rutf in niger find, read and cite all the research you. The plausibility test he lps to verify data quality and flag problems. Management of moderate acute malnutrition module 12 part 1. It is estimated that moderate acute malnutrition affects around 40 million children contributing to increased morbidity and mortality, impaired intellectual development, suboptimal adult work capacity and even increased risk of disease in adulthood. Moderate acute malnutrition severe acute malnutrition underweight 115125 mm 70 and management of severe and moderate acute malnutrition in children 209 phase of inpatient treatment of sam, prov iding children with approximately 100200 kcalkgd for th ree. Although severe acute malnutrition sam is considered a more lifethreatening condition, moderate acute malnutrition mam affects a greater proportion of children globally, and unlike sam, there are. Acute malnutrition is a spectrum condition affecting over 50 million children underage 5 each year. Kzn guidelines on the integrated management of acute. G262p the management of moderate acute malnutrition in children aged 659 months. The evidence found evaluates these protocols when used in communitybased programmes for children aged under 5 years, as well as for pregnant and lactating women plw with a child.