This Technical Brief focuses on current principles and approaches to Moderate Acute Malnutrition (MAM
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) management, highlighting key constraints, gaps in knowledge and areas still lacking consensus. It is intended to inform ongoing debates among practitioners, national partners, donors and analysts on what information and evidence on best practices are currently available, where the gaps are, and priorities for going forward.
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Maternal and child malnutrition is a significant public health problem in South Sudan. Among children aged 6-59 months, 31% are stunted, 28% are underweight, and nearly 23% are acutely malnourished of which 13% are estimated to suffer from
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moderate acute malnutrition and 10% from severe acute malnutrition.
Overall, South Sudan’s nutrition situation is worrisome, with GAM persistently above the emergency threshold in the Greater Upper Nile, Northern Bahr el Ghazal and Warrap states. Though data on micronutrient deficiencies is scanty, Vitamin A Supplementation (VAS) among children 6-59 months stood at only 2.6% in 2010, showing low uptake (SHHS, 2010). This is against a backdrop of high morbidity levels and a negligible proportion of children 6 to 23 months receiving at least the recommended minimum acceptable diet. In order to ensure optimal child growth, it is essential to ensure good nutrition and basic health care from pregnancy through two years of age (the first 1000 days).
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Integrated Management of Acute Malnutrition National Guidelines
Manual of Operations
First Edition 2016
This Technical Brief reviews current practice and evidence on nutrition-specific preventive approaches to MAM, providing practical guidance for implementers and programme managers, and highlighting gaps in evidence and guidance.
Community-Based Management of Acute Malnutrition (CMAM) is a decentralised community-based approach to treating acute
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malnutrition. Treatment is matched to the nutritional and clinical needs of the child, with the majority children receiving treatment at home using ready-to-use foods. In-patient care is provided only for complicated cases of acute malnutrition. CMAM consists of four components: (1) stabilisation care for acute malnutrition with complications, (2) out-patient therapeutic care for severe acute malnutrition without complications, (3) supplementary feeding for moderate acute malnutrition and (4) community mobilisation.
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Today, the World Health Organization (WHO) is advancing the global fight against acute malnutrition in children under 5 with the launch of its new guideline on the prevention and management of wasti
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ng and nutritional oedema (acute malnutrition). This milestone is a crucial response to the persistent global issue of acute malnutrition, which affects millions of children worldwide.
In 2015, the world committed to achieving the Sustainable Development Goals (SDGs), including the ambitious target of eliminating malnutrition in all of its forms by 2030. However, despite these commitments, the proportion of children with acute malnutrition has persisted at a worrying level, affecting an estimated 45 million children under five worldwide in 2022.
In 2022, approximately 7.3 million children received treatment for severe acute malnutrition (SAM). Although treatment coverage has increased, children with SAM in many of the worst affected countries are still unable to access the full necessary care for them to recover.
The Global Action Plan (GAP) on child wasting recognized the need for updated normative guidance to support governments in the prevention and management of acute malnutrition. WHO answered this call to action and developed a comprehensive guideline that provides evidence-based recommendations and good practice statements and will be followed by guidance and tools for implementation.
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The current guidelines on Integrated Management of Acute Malnutrition (IMAM), addresses the issue of improved management of severe acute
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malnutrition (SAM), particularly in children under 5 years of age. In the absence of standard protocols, mortality in children admitted to hospital with SAM can range between 20 -30% with the highest levels of 50-60% among those with oedematous malnutrition. With modern treatment regimens and improved access to treatment, case-fatality rates can be reduced to less than 5%. These provincial guidelines on IMAM in KZN, includes inpatient care protocols on the management of SAM, and outpatient and community outreach components to manage moderate acute malnutrition (MAM) and prevent deterioration to SAM.
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This summary assesses the current state of evidence on each approach in tabular form, providing: the definition and objectives; evidence of effectiveness; operational considerations (e.g., training, staffing, and logistics); cost considerations and evidence on cost-effectiveness; operational success
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es and challenges; and areas for future research and learning. This document is not intended to endorse any particular approach. Rather, it aims to objectively present the state of the existing evidence on each approach, so as to inform decision-making among practitioners looking to further test, refine and implement such approaches.
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Level of stunting among Bangladeshi children <5years declined from 51% in 2004 to 36% and underweight from 41% in 2007 to 33% (BDHS 2014). But the decrease in wasting rate is not as expected, which is only from 17% to 14.3 % over last decade. Approximately 3.1 % (BDHS 2014) of under-5 children suffering from SAM only b
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y weight-for-length or height z-score (WHZ) <-3 criterion and estimated to be a total of ~ 450,000. Because, there are no national information on prevalence of SAM using mid upper arm circumference (MUAC) and presence of bipedal oedema in under-5 children, thus the actual number of children suffering from SAM could be much higher than the current estimate.
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A discussion paper on the scope of the problem, its drivers, and strategies for moving forward for policy, practice, and research
In many protracted emergencies, the prevalence rates of global acute malnu
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trition (GAM) regularly exceed the emergency threshold of > 15% of children with acute malnutrition (< -2 weight-for-height z-scores (WHZ) or with nutritional edema), despite ongoing humanitarian interventions. The widespread scale and long-lasting nature of “persistent GAM” means that it is a policy and programming priority.
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(August 28 – October 10, 2017)
A nutrition and mortality assessment using SMART methodology was applied and the survey covered 15 statistical (14 districts plus 1) domains countrywide. The main objective of the survey was to assess the current nutrition status of the population, especially ch
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ildren 6-59 months old and women of reproductive age (15-49 years of age). The survey also looked at the major contextual factors contributing to undernutrition such as infant and young child feeding (IYCF) practices; food security indicators; water, sanitation and hygiene indicators; and health situation in Sierra Leone
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Public Health Action PHA 2017; 7(2): 110–115