New evidence suggests, however, that large numbers of children with severe acute malnutrition. Dec 17, 2012 cmam is a methodology for treating acute malnutrition in young children using a casefinding and triage approach. Guidelines for management of acute malnutrition through communitybased. Community based management of severe acute malnutrition was. Tina lloren, regional nutrition advisor, save the children content. For community based 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. Stunting in early childhood has health consequences that can affect children throughout their entire lives. Coverage of communitybased management of severe acute. If properly combined with a facilitybased approach for those malnourished children with medical complications and implemented on a large scale, communitybased management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children.
The i nterven tion follow s tw o appr oache s, one appr oach encour ag es local k nowle dge and pr actice s of child. The communitybased approach involves timely detection of severe acute malnutrition. Concern has been engaged in community management of acute malnutrition cmam at community, facility, district, national, and international level since 2000. Addressing acute malnutrition world vision international. The centrebased care model follows the world health organization who guidelines for management of severe malnutrition.
Hospitalization of patients with suspected malnutrition secondary to neglect allows observation of the interactions between parentcaregiver and child and documentation of actual intake and feeding difficulties. Most malnourished children can be rehabilitated at home with only a small number needing to travel for inpatient care. The approach, called communitybased management of acute malnutrition cmam, grew out of the advent of nutbased, readytouse therapeutic foods such as plumpynut. Pdf communitybased versus health facilitybased management. Submitted in partial fulfilment of the requirements for the degree of. Management of severe acute malnutrition in children. Pdf community management of acute malnutrition in the. National guidelines for community based management of. Federal bureau of prisons medical management of malnutrition undernutrition clinical guidance september 2014 4 6. Community based management of severe acute malnutrition can have a major public health impact with modern treatment regimens and improved access to treatment, casefatality rates can be as low as 5 per cent, both in the community and in healthcare facilities. Community based versus health facility based management of acute malnutrition in reducing the percentage of severe acute malnutrition sam in children 659 months of age in low and middleincome. Malawi guidelines for communitybased management of. Communitybased management of severe acute malnutrition sam 6 a communitybased approach to treating sam most children with sam without medical complications can be treated as outpatients at accessible, decentralised sites using rutf and simple medical protocols. Cmam is an evidenced based model, currently implemented in more than 70 countries worldwide, and is the globally endorsed standard for management of acute malnutrition.
Coverage as a key indicator for the management of acute malnutrition. Acute malnutrition can be moderate or severe, and prolonged malnutrition can cause stunted growth, otherwise known as stunting. Community management of acute malnutrition concern worldwide. Community based managment of acute malnutrition cmam.
Nutrition camps for community based management of acute. Community based management of acute malnutrition cmam. 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. A proposal for etiology based diagnosis in the clinical practice setting from the international. Assessment of coverage of communitybased management. The objective of the rehabilitation phase in dietary management of severe acute. Community and facilitybased interventions reduce child. Cmam involves both community and clinical interventions.
Who, unicef, and scn informal consultation on communitybased management of severe malnutrition in children. We advocate for effective and principled humanitarian action by all, for all. World vision uses the communitybased management of acute malnutrition cmam model, which strengthens communities to both identify and treat malnourished children. 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. This study was designed to establish key factors contributing to the high case fatality rate among children with severe acute malnutrition admitted to mulago hospital, uganda, to improve on these factors and to document the effect on case fatality. Integrated guidelines for the management of acute malnutrition. In 2016, 156 million children under5 suffered from stunting. Children are fed as part of a communitybased management of acute malnutrition cmam programme held at a community health center in the southern rwandan village of gisagara. Guidelines for management of acute malnutrition through community based therapeutic care ctc iii this protocol has been put together by the national community based therapeutic care programme taskforce, cofacilitated by the ministry of health and child welfare and unicef. Iv fluids in the management of severe acute malnutrition. The recently published lancet series on maternal and child under nutrition recognises sam as one of the top three nutritionrelated causes of death in children underfive years. In recent years, many countries have adopted an exciting new strategy for addressing acute malnutrition. Cardiovascular disease, cancer, celiac disease, chronic pancreatitis, chronic obstructive pulmonary disease, congestive heart failure, cystic fibrosis, dementia. Training guide for communitybased management of acute malnutrition.
It is therefore necessary to include suw children, in addition to sam cases, in a community based therapeutic feeding project. The cmam approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. Globally, moderate acute malnutrition mam and severe acute malnutrition sam affect approximately 52 million children under five. 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. Outpatient care of children with acute malnutrition.
Who communitybased management of severe acute malnutrition. Dec 21, 2015 worldwide, nearly 20 million children under five years are estimated to be suffering from severe acute malnutrition sam at any given time. Management of acute malnutrition in infants mami project. World vision treated 118,242 children with acute malnutrition in fiscal year 2017 1 october 2016 to 30 september 2017. Contents the first chapter of the guideline covers definitions, risk indicators, different types of malnutrition, and the causes, consequences and prevalence of malnutrition. National consensus workshop on management of sam children through medical nutrition therapy. It is severe acute malnutrition if the wasting is severe wh community based 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.
Community based management of acute malnutrition technical guidance brief. Ocha coordinates the global emergency response to save lives and protect people in humanitarian crises. The project trained health providers in integrated management of acute malnutrition, provided nutrition information to school children, and promoted the world health organizations infant and young child feeding practices and essential nutrition actions for improving maternal, newborn, infant, and young child health and nutrition. A joint statement by the world health organization, the world food programme, the united.
This technical brief is one of three commissioned by the community based management of acute malnutrition cmam forum. World vision uses the community based management of acute malnutrition cmam model, which strengthens communities to both identify and treat malnourished children. November 2008 a significant gap remains between need and capacity for management of severe acute malnutrition sam in children. We could not find any study on community based management of suw children. Overview of community based management of acute malnutrition. Action against hunger treats acute malnutrition with a combination of community based management and. Protocol for the management of severe acute malnutrition. Severe acute malnutrition sam is defined as a weightforheight measurement of 70% or less below the median, or three sd or more below the mean national centre for health statistics reference values, the presence of bilateral pitting oedema of nutritional origin, or a midupperarm circumference of less than 110 mm in children age 15 years. A patient with malnutrition may require hospitalization based on the severity and instability of the clinical situation. Review management of severe acute malnutrition in children. Who recommends communitybased management of acute malnutrition, but india has yet to formulate national guidelines. Recent history in the management of severe acute malnutrition sam. Communitybased management of severe acute malnutrition was. The purpose of the study was to assessthe coverage and effectiveness of the management of severe acute malnutrition project implemented in dhas district of.
Community based management of severe acute malnutrition sam 6 a community based approach to treating sam most children with sam without medical complications can be treated as outpatients at accessible, decentralised sites using rutf and simple medical protocols. Health system capacity and the cost of specialized nutrition products are major challenges with full integration into national health systems. Nepal country office and constitutes a part of a global evaluation of community management of acute malnutrition cmam that examines unicefs cmam programme performance in five countries. Picture of measurement of height and weight for children. Communitybased management of acute malnutrition cmam is. Communitybased management of severe acute malnutrition. Training guide for communitybased management of acute. Integration of community based management of acute malnutrition. Community based treatment of severe acute malnutrition sam allows the majority of malnourished children to be treated at an outpatient clinic on a weekly or fortnightly basis with only the most severe cases being admitted to inpatient centres for short periods.
Community based management of acute malnutrition, cmam, mid upper arm circumference, muac, severe acute malnutrition, sam, muac gain, weight gain correspondence. The community based management of severe acute malnutrition is an attempt to achieve sustainable impacts at a population level by taking the socioeconomic realities into account, balancing the. Ready to use therapeutic food rutf in the management of severe acute malnutrition in india. Coexistence of acute and chronic malnutrition needs to be comprehensively addressed with combined multiple approaches bergeron et al, 2012. Identifying sam in the community, often by screening children using colored plastic strips to measure midupperarm circumference. Facility based management of severe acute malnutrition. Treating malnutrition used to require that caregivers, usually mothers, transport their already fragile children to places where help was available. Communitybased management of severe acute malnutrition in. Communitybased management of acute malnutrition food. The aim is to expand the approach to reach the larger numbers of children suffering from severe acute malnutrition who live in communities untouched by emergencies. It is severe acute malnutrition if the wasting is severe wh federal bureau of prisons medical management of malnutrition undernutrition clinical guidance september 2014 2 figure 1. Community management of acute malnutrition cmam is an approach that aims to reach the most vulnerable and acutely affected children in an effort to save lives and restore good health and nutrition.
Communitybased management of severe acute malnutrition can have a major public health impact with modern treatment regimens and improved access to treatment, casefatality rates can be as low as 5 per cent, both in the community and in healthcare facilities. These stress the importance of measuring coverage and set minimum standards for key indicators. The guide complements the who guidelines and protocols for the management of acute. The communitybased management of acute malnutrition cmam is one of world visions core project models in nutrition. Facility based management of children with severe acute malnutrition according to the national survey nfhs3, 200506 1. Multisectoral nutrition s 20142025 c a technical guidance. Programmatically, it is helpful to categorise children with sam into complicated and uncomplicated cases. Management of children with severe acute malnutrition. This gap exists despite clear advances in the development and implementation of international and national protocols for the management of sam, as well as guidelines and training for inpatient care of severely acutely malnourished children. Until recently, treatment has been restricted to facility based approaches, greatly limiting its coverage and impact. Assessment of coverage of communitybased management of acute. Nutrition camps for community based management of acute malnutrition. Worldwide, nearly 20 million children under five years are estimated to be suffering from severe acute malnutrition sam at any given time.
Action communitybased management of acute malnutrition. Aim of guideline the aim of this malnutrition guideline is a timely, optimal and uniform recognition and treatment of malnutrition related to disease and ageing. A training package on outpatient management of acute malnutrition using rutf was developed and a consensus meeting was held to agree on the contents and pre tested in a combined 5 days training of trainers and service providers. The recently published lancet series on maternal and child under nutrition recognises sam as one of the top three nutritionrelated causes of.
Communitybased management of severe acute malnutrition who. A proposal for etiologybased diagnosis in the clinical practice setting from the international. Few countrieseven among those with a high prevalence of malnutritionhad a clear national policy for detecting and treating sam children. Integrated communitybased management of severe acute. Diagnosis since no single factor is conclusive in determining the presence of adult malnutrition, diagnosis should be based on identifying at least two of the following characteristics. Using the cmam method, malnourished children receive treatment suited to their nutritional and medical needs. Cmam is a methodology for treating acute malnutrition in young children using a casefinding and triage approach. Severe acute malnutrition remains a major killer of children under five years of age. The challenge of improving the management of hospitalised.
Communitybased management of acute malnutrition cmam. Communitybased management of acute malnutrition to reduce. About 9% of subsaharan african and 15% of south asian children have moderate acute malnutrition23,24 and about 2% of children in developing countries have sam. Treatment of severe and moderate acute malnutrition in low. The nutrition camps are community based nutrition pr ogr amme s for childr en who ar e a t risk of pr ot ein ener gy malnutrition. Communitybased management of acute malnutrition model. Lessons from 15 years of community management of acute. The nepal case study report was prepared by independent consultants, sheila reed, camille eric kouam. Etiologybased malnutrition definitions other chronic diseases or conditions that can result in malnutrition. The challenge of improving the management of hospitalised children with severe acute malnutrition.