The Community-based Management of Acute Malnutrition - CMAM
Transcript of The Community-based Management of Acute Malnutrition - CMAM
![Page 1: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/1.jpg)
The Community-based Management of Acute
MalnutritionAddis AbabaNovember 2011
Dr Steve Collins
Valid Nutrition / Valid International
![Page 2: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/2.jpg)
STUNTING NORMAL WASTING (CHRONIC) (ACUTE)
Picture copyright Prof Michael Golden
![Page 3: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/3.jpg)
NORMAL Low weight for age Low weight for age
Low height for age
Low MUACLow weight for
Picture copyright Prof Michael Golden
![Page 4: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/4.jpg)
Severe Acute Malnutrition is important
> 20 million children affected at any one
time
1-2 million deaths annually
Evidenced based, highly cost effective
management available
![Page 5: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/5.jpg)
Very high mortality associated with SAM
Mortality of children with severe acute malnutrition observed in longitudinal studiesCountry Mortality rateDemocratic Republic of the Congo 21%
Bangladesh 20%Senegal 20%Uganda 12%Yemen 10%
Ref WHO 2007
![Page 6: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/6.jpg)
Hospital-based clinical approaches were
resource intensive and low impact
![Page 7: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/7.jpg)
Early presentation
![Page 8: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/8.jpg)
Treating people as active consumers
of services provided new
insights
![Page 9: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/9.jpg)
Demand Driven Delivery
![Page 10: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/10.jpg)
THE CMAM model
Delivery
Product
![Page 11: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/11.jpg)
Focus on simplicity
![Page 12: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/12.jpg)
Upgrading local food industries
RUTF recipes using range of locally
grown crops
Ingredients purchased from small farmers
Link treatment with prevention – local production of RUTF
Delivered through local clinics and networks
![Page 13: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/13.jpg)
High recovery21 programs implemented in Malawi, Ethiopia Sudan &
Niger between 2001 - 2005
~78% no inpatient care
3.3% transferred & 2.3% non-recovered
N recovered died defaulted
23,511 79% 4% 11%
Lancet 2006
![Page 14: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/14.jpg)
Cost Effective
Cost outcome Bangladesh 2011
Ethiopia 2007
Malawi 2009
Zambia 2009
Recovery $180 $145
Case treated $165 $203
DALY $26 $42 $53
Sadler et al 2011
![Page 15: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/15.jpg)
2004-2005 baseline U5 years (DOWA)= 33.4 per 1000 children/years
Low relapse
Mortality 15 months post discharge from CMAM in Malawi
Bahwere et al 2009
![Page 16: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/16.jpg)
Endorsement of community-based treatment of malnutrition as preferred intervention approach
WHO
by 2010 present in 55 countries>1,000,000 cases of Severe Acute Malnutrition
treated annually
![Page 17: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/17.jpg)
Demand for Ready to Use Food
SAM related nutrition commodities ordered by UNICEF country offices( ref Duke University / UNICEF 2009)
RUTFHospital Milk products
![Page 18: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/18.jpg)
Challenges of scale-up
Transition from emergency to standard element of primary health care Funding cycleCapacity of health system Staff training – lead time for pre-service training Logistic capacity to deliver RUTF
Impact & EvidenceCoverage assessment Impact & Cost effectiveness The rush to innovate
Developmental model for CMAM Promotion of “food aid” solutions Lack of independent accreditation / certification body Access to locally produced RUTF
![Page 19: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/19.jpg)
•UNICEF purchases at least 50% global supplies. (UNICEF, MSF and Clinton Foundation approximately 80% )
•Total market at end 2010 estimated at 32,000MT
UNICEF global purchases of RUTF 2000 - 2010
RUTF MARKET
![Page 20: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/20.jpg)
RUTF manufacturing capacity 2011 (MT)
40,140
0
32,600
40,400 73000
Developing country manufacturing capacityDeveloped country manufacturingOther developed countryUS manufacturing capacity installed in past 2 years
Data UNICEF 2011
![Page 21: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/21.jpg)
Conclusion - CMAM is:
Evidence based developmental model to treat SAMDemand drivenHigh ImpactCost effectiveAn integrated approach to undernutritionIssues in transition to primary health careFunding cycles Impact monitoring - coverageTraining and logisticsUnder threat Supply side “food aid” model of AIDCo-option of name to fund poor practice
![Page 22: The Community-based Management of Acute Malnutrition - CMAM](https://reader031.fdocuments.net/reader031/viewer/2022021008/62039d1bda24ad121e4b7229/html5/thumbnails/22.jpg)
THANK YOU
Dr. Steve Collins,
Valid Nutrition / Valid International
+353 87 219 5560
www.validnutrition.org
www.validinternational.org