Global Nutrition Cluster

CMAM & Selective feeding programmes

© UNICEF/NYHQ2012-0354/Asselin

Community-based Management of Acute Malnutrition (CMAM) incorporates four main components in the identification and treatment of children affected by acute malnutrition:

  • Identification and referral of children with acute malnutrition at the community level
  • Management of children with moderate acute malnutrition (MAM) in the community
  • Management of children with severe acute malnutrition (SAM) without complications in the community
  • Management of children with SAM with medical complications or less than 6 months old though facility based care.

In recent years, there has been a proliferation of tools, guidance and resources available for CMAM; while this is positive, it also means that the guidance changes rapidly. In this section, the aim is to provide up-to-date materials and key documents that can be drawn upon during an emergency.

CMAM is also referred to as IMAM (Integrated Management of Acute Malnutrition) or CTC (Community-based Therapeutic Care).


Guidance & Standards

Moderate Acute Malnutrition: A Decision Tool for Emergencies, 2012
This tools aims to provide guidance regarding programming for moderate acute malnutrition. The MAM taskforce of the GNC drafted the tool to support practitioners in emergencies in the decision on the most appropriate intervention for the prevention and treatment of moderate acute malnutrition. It is intended to be used in collaboration with all nutrition partners during an emergency.
This tool was developed by technical experts at global level with limited consultation with the country cluster partners, regional offices and cluster coordinators. Therefore, the group agreed to initiate a review process of the tool in 6-8 countries; in a two hour meeting where partners would read the tool beforehand and provide comments on the tool within their respective country context. The comments received from the respective countries will feed into the updating of the current version of the MAM tool.

Essential Nutrition Actions:  improving maternal, newborn, infant and young child health and nutrition [link] was developed by WHO as a background for the Comprehensive Implementation Plan on maternal, infant and young child nutrition, endorsed by the World Health Assembly in its 65th meeting on May 2012. 
The document presents the interventions currently recommended by WHO, summarizes the rationale and the evidence, and describes the actions required to implement them. The document uses a life-course approach, from pre-conception throughout the first 2 years of life. It also provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. The objective of the document is to help Member States and partners in selecting interventions that are appropriate in their situation to improve health and nutrition of mothers and children, and to prevent malnutrition (undernutrition, overweight/obesity, micronutrient deficiencies). 
The publication was posted (published) on the WHO website simultaneously with the Lancet Series on Nutrition 2013.

The Lancet: Maternal and Child Nutrition, 2013 [link]
The Lancet published a Series of papers featuring new data and policy recommendations on global nutrition. The papers are a follow-up to The Lancet’s landmark 2008 Series, which helped put nutrition on the global health and development agenda and identified the 1,000 days of a mother’s pregnancy until her child’s 2nd birthday as the priority window for impact.
The Series consists of four papers and a Call to Action commentary from the authors.
Paper 1 considers the prevalence and consequences of nutritional conditions during the life course from adolescence (for girls) through pregnancy to childhood and discusses the implications for adult health.

  • Paper 2 covers the evidence supporting the nutrition-specific interventions and the health impact and cost of increasing their population coverage.
  • Paper 3 considers nutrition-sensitive interventions and approaches and their potential to improve nutrition.
  • Paper 4 examines the features of an enabling environment that are needed to provide support for nutrition programs, and how they can be favourably influenced.
  • The Comment examines what is currently being done, and what should be done nationally and internationally to address nutritional and developmental needs of women and children in low- and middle-income countries.

Guidelines for Selective Feeding: The Management of Malnutrition in Emergencies, UNHCR/WFP, 2011
This guide is intended as a practical guide to design, implement, monitor and evaluate selective feeding programmes in emergencies, to help in deciding which type of programmes are required and how they should be implemented. Topics covered include: acute malnutrition and micronutrient deficiencies, general food distribution, therapeutic and supplementary feeding programmes, monitoring and evaluation and complementary interventions. The guide is available in English [pdf] and French [pdf] and also includes a separate extensive Annotated Bibliography [pdf].

Generic Guidelines and Job Aids for Community-Based Management of Acute Malnutrition (CMAM), FANTA, 2010, Draft Version
This package includes generic guidelines and many job aids (forms, handouts, laminations, reports and training aids) for CMAM. While this package is still under revision, since the materials will have to be adapted according to each individual countries context, these drafts are a useful foundation for this process.

Community-based Therapeutic Care (CTC), A Field Manual, Valid International, 2006
This field manual was developed by Valid International in collaboration with Concern Worldwide. It is a practical guide that provides program managers, practitioners, and technical specialists addressing severe acute malnutrition with the essential design, implementation and evaluation protocols for implementing the CTC approach.

Management of Acute Malnutrition in Infants (MAMI) Project, 2009 [pdf]
This document aimed to review the management of acute malnutrition in infants less than six month old in emergency programmes. It examined the burden of malnutrition in infants, current guidance, policies and strategies, as well as how programmes are carried out in practice, with recommendations for future practice and research.

WHO Child Growth Standards can be downloaded in various forms as well as in English and French. Weight-for-Length, Weight-for-Height

Joint Statement by WHO and UNICEF: WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children, 2009
This joint statement provides recommendations and the rationale for the adoption of the WHO Child Growth Standards in the management of severe acute malnutrition. It also discusses programmatic implications of this change. The statement is available in English [pdf] and French [pdf].

Fact sheet on the implementation of 2006 WHO Child Growth, 2009
This fact sheet aims to provide a standard framework and guidance on transitioning from the 1977 National Centre for Health Statistics/WHO growth reference (NCHS reference) to the 2006 WHO Child Growth Standards (WHO standards) for emergency nutrition surveys and new and existing emergency nutrition programmes for the management of acute malnutrition. It attempts to answer the most common questions that may arise during the transition process. English, French, Spanish, Arabic [pdf]

Tools & Other Resources

CMAM Forum
The CMAM Forum was established in 2012 by a group of experts with the aim to provide a robust information-sharing mechanism that expands the knowledge base on acute malnutrition to improve health outcomes for vulnerable populations. The website brings together the wealth of resources related to CMAM with open access areas that include: resources, training, advocacy, and country specific documents; member areas include: Research, FAQs, technical briefs, and a contact mechanism. 

Coverage Assessment Resource Kit, Valid International
This is an interactive multimedia resource kit developed as a documentation of Valid International's Workshop on Coverage Assessment Methods held in March 2012. The kit contains the proceedings, presentations and technical references from the workshop as well as other resources including journal articles, software and links.

Mid Upper Arm Circumference and Weight-for-Height Z-score as indicators of severe acute malnutrition: a consultation of operational agencies and academic specialists to understand the evidence, identify knowledge gaps and to inform operational guidance.

The consultation was instigated by Save the Children UK (SC UK) and facilitated by the Emergency Nutrition Network (ENN). It aimed to identify common challenges, wider experiences and additional evidence regarding MUAC and WHZ use in the context of CMAM interventions, and to reach a shared understanding of the operational issues, existing and upcoming evidence and implications for programming.
The report represents the final stage outcomes of the four-month consultation process, which involved 19 academic specialists and 10 operational organisations. Thre consultation sought to complement and inform the WHO Nutrition Guideline Advisory Group (NUGAG) process that was instigated in February 2012.

Sample database for CMAM programme monitoring
CMAM databases are a tool used three main reasons: 1) to track the number of children receiving treatment for malnutrition, 2) to support supply need forecasting and consumption monitoring, and 3) to monitor programme quality through the calculation of key indicators, such as cure rates, defaulter rates, death rates, etc. As CMAM programmes vary from country to country, databases to monitor programme implementation also vary a great deal. Here several options are included of CMAM databases.

  • South Sudan [zip file] - includes tracking and monitoring for all nutrition emergency interventions 
  • Mali [xls] - includes 3W tool

CMAM Forecasting Tool [xls]
This tool aids in estimating the expected caseload for CMAM programmes and automatically translates that into supply needs for each programme component. While this tool is useful as an estimate of the needs, there are limitations that must be considered during its application as it is based on assumptions regarding population figures, prevalence of malnutrition, and programme coverage. Costs of each commodity and shipping must be confirmed before accurate estimates can be determined.

CMAM Costing Tool & User Guide, FANTA, 2011
The CMAM Costing Tool is a Microsoft Excel-based application that estimates the costs of implementing CMAM at the national, sub-national, and district levels. It calculates the inputs and financial resources required to establish, maintain, or expand CMAM services. The User's Guide aims to explain the scope and limitations of the Tool, outlines the different worksheets and data required, and provides guidance on analysing the results. Costing Tool and User Guide available in both English and French [link]. 



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