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Management of Acute Malnutrition in Infants under six months (MAMI)

Donors: OFDA, Irish Aid

Collaborators: LSHTM, University of Washington, KEMRI, WHO, UNHCR, UNICEF, Save the Children, ACF, Goal and independent experts.

ENN project lead: Marie McGrath

Timeframe: 2010 - ongoing 

Project Summary 

MAMI concerns the identification and care of nutritionally vulnerable infants under 6 months and their mothers. 

ENN coordinate an informal MAMI Interest Group of practitioners and researchers involved in MAMI research and programming. ENN collaborates closely with the London School of Hygiene and Tropical Medicine (LSHTM), and non-governmental organisations, such as Save the Children, to undertake research and reviews to generate evidenced guidance to improve programming (see list of research and reviews below). 

ENN also hosts meetings of the MAMI interest group (see list below) and is a member of the CORTASAM of the No Waste d Lives Initiative, representing a MAMI interest. 

ENN’s online technical forum, en-net, includes a MAMI thematic area. Click here to view and participate. 

If you would like to engage with us on MAMI, contact Marie McGrath

Key activities to date

C-MAMI tool

A simple, short practical tool to support community-based management of uncomplicated cases of acute malnutrition in infants under six months of age (C-MAMI) was developed by ENN in 2015. Modelled on, and complementing, the Integrated Management of Childhood Illness (IMCI) framework, it provides practical guidance to help put the WHO 2013 guidance into practice. It draws on existing relevant content and tools and was peer reviewed by a ‘circle’ of experts and practitioners. Version 1.0 of the tool is now available here.  We welcome feedback and are actively pursuing opportunities to pilot the tool.

MAMI research and reviews

ENN is technical advisor on research led by Save the Children in Bangladesh, to investigate the burden of acute malnutrition in infants under six months and explore perceptions of caregivers and health workers regarding community based treatment options. This research is being finalised for peer review publication. A new phase will involve piloting the C-MAMI tool in Bangladesh and Myanmar, led by Save the Children.

ENN is currently collaborating with researchers at LSHTM on a review of experiences and challenges regarding the current anthropometric case definition for acute malnutrition in infants under 6 months. A similar collaboration undertook secondary data analysis to explore infant, maternal and household factors associated with acute malnutrition in infants under six months. This is being finalised for peer review publication.

An updated review of the MAMI-specific content of national acute malnutrition treatment guidelines, built on a 2010 review (published in the MAMI report) and updated to inform the 2013 WHO SAM guidance update, funded by OFDA, Irish Aid and Save the Children funding to the ENN. This paper is being finalised for peer review publication.

Grijalva-Eternod, C.S., Kerac, M., McGrath, M., Wikinson, C., Hirsch, J.C., Delchevalerie, P. and Seal, A.J. (2016) Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis. Matern Child Nutr. 2016 Jul 25, doi: 10.1111/mcn.12345. Funded by OFDA to the ENN.

Angood et al (2015) Research priorities to improve the management of acute malnutrition in infants aged less than six months (MAMI)

 

MAMI Meetings 

In 2017, the ENN will host a MAMI Interest Group meeting, synergising with other ENN initiatives, such as the WAST TIG, and external groups. To find out more email Marie McGrath.

On 27th January 2016, ENN, LSHTM and Save the Children co-hosted a one day meeting of a Management of Acute Malnutrition in Infants under 6 months (MAMI) Interest Group in London. The meeting was funded by Save the Children (Margaret A. Cargill Foundation grant for forwarding Management of Acute Malnutrition in Infants research) and ENN (Irish Aid). There were 29 participants. The meeting report is now available and presentations are available on request.

The meeting was prompted to facilitate exchange of experiences, policy and research relevant to MAMI, to identify opportunities to engage with reproductive and neonatal health, and to spotlight emerging research priorities in order that partners can mobilise resources to address these moving forward.

A key recommendation emerging from the meeting was that WHO review the evidence base for the case definition of SAM in infants under 6 months of age.  This has informed ENNs current evidence review, due for completion the first quarter of 2017.

Read more...

Background to ENN & MAMI

Experiences shared with the ENN through our publication Field Exchange (FEX), and the development of training materials on infant feeding in emergencies, highlighted problems managing acute management in infants < 6 months in NGO supported humanitarian operations. The ENNs research interest in this area has two phases: the first phase saw an investigation of MAMI in NGO supported humanitarian programmes which culminated in a MAMI Report, completed in early 2010. Informed by the ENN-led 2010 MAMI Report, infants under six months are specifically addressed for the first time in the 2013 WHO Updates on the management of severe acute malnutrition in infants and children. Outpatient treatment is now an option for uncomplicated cases, while retaining inpatient care for complicated cases.

In the current phase ENN's work in MAMI is informed by a network of interested and active researchers and practitioners from academic institutions (such as LSHTM, University of Washington, KEMRI), organisations (such as  WHO, UNHCR, UNICEF, Save the Children, ACF and Goal) and independent experts. We act to facilitate and capture MAMI related learning, identify constraints in programming, support evidence development (through informed research agendas, research and reviews) and help fill gaps in policy and guidance.

The centrality of the mother-infant dyad, the necessity to address women’s nutrition and health particularly in pregnancy and including adolescence, and the importance of nutrition sensitive (multi-sectoral) approaches that complement nutrition-specific interventions, are at the heart of our MAMI vision.

 

 

 

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Reference this page

Chloe Angood (2016). Management of Acute Malnutrition in Infants under six months (MAMI). www.ennonline.net/ourwork/research/mami