Who communitybased management of severe acute malnutrition. The communitybased management of acute malnutrition cmam is one of world visions core project models in nutrition. Action communitybased management of acute malnutrition. The communitybased approach involves timely detection of severe acute malnutrition in the community and provision of treatment for those without medical complications with readytouse therapeutic foods or other nutrientdense foods at home. Who, unicef, and scn informal consultation on communitybased management of severe malnutrition in children. Approximately, 8590% of severely malnourished children those who do not have medical. Community based management of severe acute malnutrition. This gap exists despite clear advances in the development and implementation of international and national protocols for. Moderate acute malnutrition mam severe acute malnutrition sam which is further classified as.
Costeffectiveness of communitybased screening and treatment. 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. Despite major accomplishment in reducing child mortality and maternal mortality malnutrition remains a challenge in bangladesh. Community based management of acute malnutrition in bangladesh 5 national guidelines for bangladesh made impressive progress with under nutrition and achieved the mdg goals for undernourishment and underweight children ahead of schedule. Review of community based management of acute malnutrition implementation in west africa.
Communitybased management of acute malnutrition cmam in. Effectiveness and principles of community based management of acute malnutrition cmam cmam is a useful approach to rehabilitating malnourished children and reducing childhood mortality attributed to acute malnutrition. The approach is effective due to several reasons which are community based. Communitybased management of severe acute malnutrition. Communitybased management of severe acute malnutrition was introduced in emergency situations.
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. Inpatient treatment for children with sam and medical complications andor no appetite. Communitybased management of acute malnutrition model. Communitybased management of child malnutrition in zambia. Building community capacity cmam programmes work with communities to identify, manage and prevent acute malnutrition. Communitybased management of severe acute malnutrition was introduced in emergency. Based management of acute malnutrition cmam 2 module 1. Malnutrition is the end result of chronic nutritional and, frequently. Community based management of severe acute malnutrition was. 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. Pdf community management of acute malnutrition in the. Outpatient care for the management of severe acute malnutrition sam without medical complications. May 17, 2018 imam stands for integrated management of acute malnutrition it is an integrated program to fight back against acute malnutrition. Assessment of coverage of communitybased management of acute.
However, the challenge remains in improving the nutritional status of children and women in bangladesh. Communitybased management of acute malnutrition cmam is. Lack of food intake refers to a lack in either the quality or quantity of food eaten by a child. 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. The sensitivity analysis shows that if all variables are in their assumed worst case scenario the programme is still costeffective. Many studies have discussed evidencebased possible interventions to address sam. If properly combined with a facility based approach for those malnourished children with medical complications or below 6 months and implemented on a large scale, community based management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children. In 2016, 156 million children under5 suffered from stunting. Malawi guidelines for communitybased management of acute malnutrition, 2nd edition 7.
Learning objectives discuss acute malnutrition and the need for a response. 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. 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. Objective to document, as case studies, the experi ence of three african countries, malawi, ghana, and zambia, in scaling up cmam. Protocol for the management of severe acute malnutrition.
That is, the medical problems of the child result, in part, from the social problems of the home in which the child lives. Communitybased management of acute malnutrition in bangladesh. Multisectoral nutrition s 20142025 c a technical guidance. Malawi guidelines for communitybased management of acute. In afghanistan, child malnutrition is one of the most serious public health problem and the highest in the world.
If properly combined with a facilitybased approach for those malnourished children with medical complications or below 6 months and implemented on a large scale, communitybased management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children. Communitybased management of severe acute malnutrition a joint statement by the world health organization, the world food programme, the united nations system standing committee on nutrition and the united nations childrens fund. The management of sam and mam are 2 of the 10 interventions. The implementation of community based management of acute malnutrition cmam as the standard model of care for children with acute malnutrition has significantly increased costeffectiveness of the treatment and the potential for larger coverage, largely due to a shift from inpatient to outpatient management. Pdf communitybased management of severe acute malnutrition. Guidelines for management of acute malnutrition through communitybased therapeutic care ctc iii this protocol has been put together by the national communitybased therapeutic care programme taskforce, cofacilitated by the ministry of health and child welfare and unicef. The brief focuses on current principles and approaches to moderate acute malnutrition mam management, highlighting key constraints, gaps. If properly combined with a facilitybased approach for those malnourished children. A retrospective study was conducted on a sample of 1266 zambian malnourished children assisted from 2012 to 2014 in the rainbow project sfps.
Community based management of severe acute malnutrition cmam is based on the fundamental principle that children whose lives are at risk because of sam should receive timely and appropriate care and assistance. This technical brief is one of three commissioned by the community based management of acute malnutrition cmam forum. Health system capacity and the cost of specialized nutrition products are major challenges with full integration into national health systems. 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. Doctors and nurses and nutrition specialists and epidemiologists in the local community are an invaluable source of information regarding the predisaster nutritional status of the pediatric population. Achieving these goals will maximise impact and the capacity of the service to meet need. National guidelines for community based management of acute malnutrition cmam, july 2017. The aim and priority in community based services for the management of acute malnutrition is to reach as many of those affected as possible and to access acutely malnourished children in the early stages of their disease. Community management of acute malnutrition cmam is a widelyaccepted approach to addressing acute malnutrition in children under the age of five.
Their involvement in nutritional assessments and food resource planning is recognition and management of malnutrition 8 daniel martinezgarcia md. Coverage of communitybased management of severe acute. The guide complements the who guidelines and protocols for the management of acute. Training guide for communitybased management of acute. Review of community based management of acute malnutrition in west africa. The community mobilisation part of these guidelines can usefully provide a starting point for such programmes. Overview of community based management of acute malnutrition. Classification for the community based treatment of acute malnutrition acute malnutrition severe acute malnutrition with medical complications severe acute malnutrition without medical complications moderate acute malnutrition without medical complications inpatient care outpatient care supplementary feeding. Communitybased management of child malnutrition in. Communitybased management of severe acute malnutrition in. Community based management of acute malnutrition cmam. Costeffectiveness of communitybased management of acute. Community based management of severe acute malnutrition was introduced in emergency. Communitybased management of acute malnutrition cmam.
Key messages of imam integrated management of acute. Training guide for communitybased management of acute malnutrition. Training guide for 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. Innovations in community management of acute malnutrition cmam. Identifying sam in the community, often by screening children using colored plastic strips to measure midupperarm circumference. Communitybased management of acute malnutrition givewell. Ministry of health and family welfare is fully committed to provide. 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.
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. A varied diet complete in macro and micronutrients is essential to health and normal growth. Feasibility and constraints article pdf available in food and nutrition bulletin 352 july 2014 with 735 reads. National guidelines for community based management of acute. The communitybased approach involves timely detection of severe acute malnutrition. This technical brief is one of three commissioned by the communitybased management of acute malnutrition cmam forum. Malawi guidelines for communitybased management of. It is a nutritional program designed especially for children of 659 months of age and is a very important concept for management of malnutrition. Community management of acute malnutrition cmam is a proven approach to manage sam and mam in children under 5 and is currently implemented in more than 70 countries unicef, 20. Recent success with community based management of acute malnutrition cmam has spurred interest on how to improve coverage while maintaining treatment outcomes. Severe acute malnutrition remains a major killer of children under five years of age. Communitybased management of acute malnutrition cmam is a.
Only foods and feeding practices that are affordable, feasible, and acceptable to families should be recommended. Assessment of coverage of communitybased management. Sep 26, 2018 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. Severe malnutrition is both a medical and a social disorder. Community based management of acute malnutrition cmam communitybased management of acute malnutrition cmam is a decentralised communitybased approach to treating acute malnutrition. Few countrieseven among those with a high prevalence of malnutritionhad a clear national policy for detecting and treating sam children. Cmam is an evidencedbased model, currently implemented in more than 70 countries worldwide, and is the globally endorsed standard for management of acute malnutrition. International workshop on the integration of community based management of acute malnutrition. Communitybased management of acute malnutrition unicefs.
Overview of communitybased management of acute malnutrition cmam 1. Dec 17, 2012 the community based management of acute malnutrition cmam approach enables community volunteers to identify and initiate treatment for children with acute malnutrition before they become seriously ill. Communitybased management of acute malnutrition in. Integration of community based management of acute malnutrition. Community based management of acute malnutrition cmam is a strategy for identifying and treating uncomplicated sam without requiring hospitalization. Community based management of acute malnutrition in bangladesh 3 national guidelines for improving nutrition in bangladesh is essential to the countrys progress. Treatment is matched to the nutritional and clinical needs of the child, with the majority children receiving treatment at home using readytouse foods.
Community based management of acute malnutrition in bangladesh 3 we have made substantial progress in health and population sector in recent time particularly in reducing child mortality and maternal mortality. The communitybased management of acute malnutrition. This increases community ownership of malnutrition, which in turn increases participation in treatment and prevention activities. Communitybased management of severe acute malnutrition who. Nutritional status was evaluated according to whounicef methodology. 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. 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. Scaling up communitybased management of acute malnutrition. Community based management of acute malnutrition technical guidance brief. Table 1 costing analysis of community based screening and treatment of acute malnutrition in mali activity cost per child 2015 usd % of activity total comments 1. Based on 2007 programme data and a number of key assumptions, communitybased management of acute malnutrition cmam in dowa, malawi was highly costeffective using the gni per capita threshold. Outpatient treatment for children with sam with a good appetite and without medical complications 4.
The cmam approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. Pdf communitybased management of acute malnutrition in. Communitybased 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. Review of community based management of acute malnutrition implementation in west africa implementation, and m ost nutrition partners, i. Jun 04, 2015 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.