Ocha coordinates the global emergency response to save lives and protect people in humanitarian crises. Concern has been engaged in community management of acute malnutrition cmam at community, facility, district, national, and international level since 2000. 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. Who recommends communitybased management of acute malnutrition, but india has yet to formulate national guidelines. 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. Multisectoral nutrition s 20142025 c a technical guidance. Programmatically, it is helpful to categorise children with sam into complicated and uncomplicated cases.
World vision uses the community based management of acute malnutrition cmam model, which strengthens communities to both identify and treat malnourished children. A patient with malnutrition may require hospitalization based on the severity and instability of the clinical situation. Lessons from 15 years of community management of acute. New evidence suggests, however, that large numbers of children with severe acute malnutrition. National guidelines for community based management of. Protocol for the management of severe acute malnutrition. Integrated communitybased management of severe acute. November 2008 a significant gap remains between need and capacity for management of severe acute malnutrition sam in children.
Iv fluids in the management of severe acute malnutrition. Training guide for communitybased management of acute malnutrition. 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. 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. Overview of community based management of acute malnutrition. 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. Submitted in partial fulfilment of the requirements for the degree of. 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. Action against hunger treats acute malnutrition with a combination of community based management and.
Health system capacity and the cost of specialized nutrition products are major challenges with full integration into national health systems. Federal bureau of prisons medical management of malnutrition undernutrition clinical guidance september 2014 4 6. Worldwide, nearly 20 million children under five years are estimated to be suffering from severe acute malnutrition sam at any given time. 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. Communitybased management of acute malnutrition cmam is. 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. The centrebased care model follows the world health organization who guidelines for management of severe malnutrition. 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. We could not find any study on community based management of suw children. Community based management of acute malnutrition cmam. 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. Using the cmam method, malnourished children receive treatment suited to their nutritional and medical needs.
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. 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 acute malnutrition, cmam, mid upper arm circumference, muac, severe acute malnutrition, sam, muac gain, weight gain correspondence. Guidelines for management of acute malnutrition through communitybased. Facility based management of children with severe acute malnutrition according to the national survey nfhs3, 200506 1. Facility based management of severe acute malnutrition. 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. Management of acute malnutrition in infants mami project. National consensus workshop on management of sam children through medical nutrition therapy.
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. 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 technical guidance brief. 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. Treatment of severe and moderate acute malnutrition in low. In 2016, 156 million children under5 suffered from stunting. Cardiovascular disease, cancer, celiac disease, chronic pancreatitis, chronic obstructive pulmonary disease, congestive heart failure, cystic fibrosis, dementia. World vision uses the communitybased management of acute malnutrition cmam model, which strengthens communities to both identify and treat malnourished children. 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. Acute malnutrition can be moderate or severe, and prolonged malnutrition can cause stunted growth, otherwise known as stunting. 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. 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. Coverage of communitybased management of severe acute. Community based management of severe acute malnutrition was.
In recent years, many countries have adopted an exciting new strategy for addressing acute malnutrition. 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. Action communitybased management of acute malnutrition. 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. Identifying sam in the community, often by screening children using colored plastic strips to measure midupperarm circumference. Coexistence of acute and chronic malnutrition needs to be comprehensively addressed with combined multiple approaches bergeron et al, 2012. Tina lloren, regional nutrition advisor, save the children content. Globally, moderate acute malnutrition mam and severe acute malnutrition sam affect approximately 52 million children under five.
Review management of severe acute malnutrition in children. Dec 17, 2012 cmam is a methodology for treating acute malnutrition in young children using a casefinding and triage approach. Who communitybased management of severe acute malnutrition. 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. Cmam involves both community and clinical interventions. Community and facilitybased interventions reduce child. The recently published lancet series on maternal and child under nutrition recognises sam as one of the top three nutritionrelated causes of. 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 joint statement by the world health organization, the world food programme, the united. The cmam approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. 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.
We advocate for effective and principled humanitarian action by all, for all. Assessment of coverage of communitybased management of acute. This technical brief is one of three commissioned by the community based management of acute malnutrition cmam forum. The approach, called communitybased management of acute malnutrition cmam, grew out of the advent of nutbased, readytouse therapeutic foods such as plumpynut. Outpatient care of children with acute malnutrition. Communitybased management of severe acute malnutrition. Communitybased management of severe acute malnutrition was. 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. The objective of the rehabilitation phase in dietary management of severe acute. These stress the importance of measuring coverage and set minimum standards for key indicators. 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. Pdf community management of acute malnutrition in the.
Recent history in the management of severe acute malnutrition sam. The communitybased approach involves timely detection of severe acute malnutrition. Communitybased management of severe acute malnutrition who. Communitybased management of acute malnutrition food. Assessment of coverage of communitybased management. The communitybased management of acute malnutrition cmam is one of world visions core project models in nutrition. Malawi guidelines for communitybased management of. Addressing acute malnutrition world vision international.
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. Etiologybased malnutrition definitions other chronic diseases or conditions that can result in malnutrition. It is therefore necessary to include suw children, in addition to sam cases, in a community based therapeutic feeding project. 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. 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. World vision treated 118,242 children with acute malnutrition in fiscal year 2017 1 october 2016 to 30 september 2017.
Until recently, treatment has been restricted to facility based approaches, greatly limiting its coverage and impact. Most malnourished children can be rehabilitated at home with only a small number needing to travel for inpatient care. Who, unicef, and scn informal consultation on communitybased management of severe malnutrition in children. The challenge of improving the management of hospitalised.
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. Stunting in early childhood has health consequences that can affect children throughout their entire lives. Malawi guidelines for communitybased management of acute. Severe acute malnutrition remains a major killer of children under five years of age. 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. Picture of measurement of height and weight for children. Pdf communitybased versus health facilitybased management. Community based managment of acute malnutrition cmam. Communitybased management of severe acute malnutrition in. Communitybased management of acute malnutrition to reduce. Treating malnutrition used to require that caregivers, usually mothers, transport their already fragile children to places where help was available.
Management of children with severe acute malnutrition. 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. Communitybased management of acute malnutrition model. 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.
Nutrition camps for community based management of acute malnutrition. Community management of acute malnutrition concern worldwide. Coverage as a key indicator for the management of acute malnutrition. Ready to use therapeutic food rutf in the management of severe acute malnutrition in india.
Integration of community based management of acute malnutrition. The guide complements the who guidelines and protocols for the management of acute. Cmam is a methodology for treating acute malnutrition in young children using a casefinding and triage approach. The 2011 sphere standards3 see box 1 set the minimum acceptable levels of coverage for the management of acute malnutrition in different settings during a humanitarian response. 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. A proposal for etiology based diagnosis in the clinical practice setting from the international. 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 acute malnutrition cmam. Management of severe acute malnutrition in children. The nepal case study report was prepared by independent consultants, sheila reed, camille eric kouam. The challenge of improving the management of hospitalised children with severe acute malnutrition.