Management of Acute Malnutrition in Infants less than 6 months (MAMI)
The Management of Acute Malnutrition in Infants under 6 months of age Project (MAMI-1) was a collaborative effort (2008-2010) between ENN, University College London Centre for International Health and Development (CIHD) London and Action Contre la Faim, funded by the UNICEF-led IASC Nutrition Cluster. The MAMI-1 ‘core’ team was supported by a research advisory group, an interagency steering group, UN agencies, NGOs and independent individuals with relevant experiences.
The aim of the MAMI Project was to investigate the management of acutely malnourished infants under six months of age (infants <6m) in emergency programmes, in order to improve practice by contributing to evidence-based, better practice guidelines.
Key findings included:
- Large numbers of affected infants worldwide: an estimated 3.8 million severely wasted and 4.5 million moderately wasted (WHZ <-3 and ≥-3 to <-2 respectively, WHO Standards).
- Higher mortality among infants <6m compared to children in the same treatment programmes – but no clear evidence as to how much of this might be avoidable with different treatments.
- Country guidelines focused on inpatient-based treatment for infants <6 months – in stark contrast to ‘Community Management of Acute Malnutrition’ for older children.
Summary Report Full Report Full report by chapter
MAMI-1 has achieved one of its strategic goals: to highlight the need to tackle severe acute malnutrition (SAM) in infants <6 months. This age group are considered in forthcoming guidelines arising from a WHO Nutrition Guidance Expert Advisory Group (NUGAG) consultation in February 2012. This is a significant step forward.
Whilst the NUGAG recommendations will recognise the need to manage acute malnutrition in this age group, there remain many unanswered questions around how to. MAMI-1’s call for more published data and evidence is all the more urgent. The ENN, UCL and ACF, as the original MAMI-1 core partners, are working to realise a new phase of work to address some of these gaps (MAMI-2).
It is important to prioritise those research questions with greatest potential impact on improving outcomes. Over July and August 2012, we will be applying the Child Health and Nutrition Research Initiative (CHNRI) framework to MAMI. The intended output is a peer-reviewed paper in which all possible questions will be ranked and discussed. This can be used as a key reference to generate dialogue, policy, and also help agencies apply for both programme and research funding on the theme.
If you would like to take part in the research prioritisation exercise, please contact us.
We welcome dialogue with individuals and agencies wishing to become more closely involved in MAMI-2 efforts, including those working in reproductive health, psychosocial health, neonatal health, etc. Contact Marie McGrath at ENN or Marko Kerac at UCL.
MAMI publications and presentations
Prevalence of wasting among under 6-month-old infants in developing countries and implications of new case definitions using WHO growth standards:a secondary data analysis. February 2011.
Kerac M, McGrath M; Shoham J, Bizouerne C, Wilkinson C, Seal A. 'Clinical signs of young infant illness and MAMI (Management of Acute Malnutrition in Infants)'. Online comment, Lancet, February 18 2008. Response to: Clinical signs that predict severe illness in children under age 2 months: a multicentre study. The Lancet - Vol. 371, Number 9607, 12 January 2008, Pages 135-142.
Poster presentation at Royal Society of Tropical Medicine meeting in London, 2008.
Archives of Diseases in Childhood 2009;94(Supplement 1):A49-A51 Abstract on disease burden and risk-benefit implications of 2006 WHO Growth Standards on SAM in infants <6m.
MSF Scientific Day presentation in London on 10th June 2009.
CAPGAN, Malawi, 2009. Conference abstracts (MAMI Project, p8).
UN SCN presentation (Nutrition in emergencies working group), October, 2009