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

Highlights

MAMI Meeting 2016 

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.  Please let ENN know if you are undertaking research with this age group and your anticipated publication schedule.

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

MAMI Thematic Area on en-net

Since 2015, a ‘MAMI’ thematic area has been operating on ENN’s online forum ‘en-net’ to support those working with this age group. Click here to view and participate. 

MAMI Interest Group

ENN is the coordinating agency for the MAMI Interest Group, an informal network of researchers and practitioners involved in the care of nutritionally vulnerable infants under 6 months and their carers.  For more information, contact: Marie McGrath.

Background to ENN & MAMI

Experiences shared with the ENN, through Field Exchange and in 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.

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.

ENN MAMI activities

Influencing policy guidance

Informed by the ENN-led 2010 MAMI Report, a review funded by the Global Nutrition Cluster (GNC), 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.

Prioritising MAMI research

We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to score research options in a consultation with 64 experts on a list of 60 questions. This has been published in Plos Med, entitled "Research Priorities to Improve the Management of Acute Malnutrition in Infants Aged Less Than Six Months (MAMI)" by Angood et al. Click here to view. We hope it will inform researchers on their research agenda, and encourage a coordinated approach to research. It provided a guiding framework for the MAMI Interest Group meeting in January 2016 (see above).

 ENN is also a technical advisor on Save the Children led research on MAMI in Bangladesh.

Analysis of NGO MAMI programme data

As part of the MAMI 2010 review, secondary data analysis of admission and discharge data from inpatient therapeutic care in 10 countries was undertaken.  Funded by OFDA funding to the ENN, a paper that describes the outcome of analysis, challenges and implications for programming in this area has been co-authored by ENN, LSHTM, UCL, UNHCR, MSF and ACF and submitted for peer review publication.

Review of national malnutrition treatment guidelines regarding MAMI

ENN has co-authored an updated review of the MAMI-specific content of national acute malnutrition treatment guidelines. This built on the review undertaken in the 2010 MAMI Report and subsequently updated to inform the 2013 WHO SAM guidance update. The lead author is Marko Kerac, LSHTM. The paper has been submitted for peer review publication. The 2015 update was funded by OFDA, Irish Aid and Save the Children funding to ENN. 

Population level risk factors for acute malnutrition in infants under 6 months

A researcher from LSTHM, engaged by ENN, has undertaken a detailed analysis of DHS country data to explore risk factors for acute malnutrition in infants less than 6 months to inform areas of research, collaboration and intervention. A paper has been submitted for peer review publication. The analysis was supported by OFDA, Irish Aid and Save the Children funding to ENN. 

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.

 

 

 

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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