MAMI Interest Group meeting
On 27th January 2016, ENN, London School of Hygiene and Tropical Medicine (LSHTM) and Save the Children co-hosted a one day meeting of a Management of Acute Malnutrition in Infants under 6 months (MAMI) Interest Group1 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). Twenty-nine participants represented WHO, UNICEF, UNHCR, CDC, OFDA, DFID, NGOs (Concern, Goal, Save the Children, ACF, IRC), field-based researchers (Malawi, Kenya), research institutions (LSHTM, UCL, Wellcome Trust, University of Tampere, KEMRI, Fogarty International Centre, Aga Khan University), neonatal and obstetric health, and ENN.
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, to share planned activities, and to spotlight emerging research priorities in order that partners can mobilise resources to address these moving forward.
Three presentation sessions (background/epidemiology, interventions and linking and learning with others) were followed by group work to identify priority actions and research. Presentations and research priorities were reviewed to see if they contributed to the top 15 MAMI research questions identified in a 2015 Child Health and Nutrition Research Initiative (CHNRI) MAMI research prioritisation2, and the priority WHO research questions for this age group noted in the WHO Guideline on Updates on the Management of Severe Acute Malnutrition in Infants and Children released in 20133
Overview of presentations
A WHO update on the status of MAMI related guidance & training, reinforced important initiatives to engage with including an Integrated Management of Childhood Illness (IMCI) Strategic Review planned for early 2016.
Secondary analysis of DHS data identified risk factors for acute malnutrition in infants <6m as household sanitation, maternal education, maternal nutrition, domestic violence, antenatal care practices and early breastfeeding practices.
Operational research findings were shared from Bangladesh (Save the Children), Malawi (LSHTM) and Kenya (KEMRI clinical trial). An important research initiative currently being pursued is the Improved Breastfeeding Support to Treat Acute Malnutrition amongst Infants under 6 months (IBAMI) research, that is planned for inpatient and community (follow-up) settings in Kenya. It aims to experiment with different approaches of home-based counselling (intensive/less intensive), borrowing approaches from mother-to-mother community support groups, which are working well in Kenya, and bring these into the clinic setting. The aim is to try to optimise breastfeeding as far as possible and see outcomes result.
Experiences of integrating infant screening (using MUAC) and programme admissions into operational settings were shared by GOAL from Ethiopia and with GOAL’s GOAL’s multi-country Nutrition Impact & Positive Practice (NIPP) Circle project.
An updated review of SAM treatment national guidelines reflected that community-based management of malnutrition in infants< 6m is not yet reflected in national protocols (one exception out of 46 national protocols). An overview of the C-MAMI Tool was presented. This ENN/LSHTM led initiative involving a peer review group of practitioners and experts, developed as a simple, first step stop-gap to help operationalise the 2013 WHO guidance regarding community based management of uncomplicated infants <6m.
Synergies and common ground between MAMI and both the Every Newborn Action Plan and Intergrowth and INTERBIO-21st study emerged in presentations and discussion.
Ongoing body composition research in Ethiopia is taking a fresh look at anthropometric criteria, looking to improve understanding on relations between growth and disease risk through life. An emerging hypothesis from this work is that MUAC reflects growth (nutritional vulnerability) while WLZ more closely reflects nutritional status.
Priority actions and research
Top priorities identified were:
WHO should review the evidence base for the case definition of SAM in infants < 6m, with particular consideration to its association with the risk of death. Currently, weight-for-height (WHZ) is the sole anthropometric diagnostic criterion for SAM in children under 6 months. The possible use of MUAC and WFA and the need to keep WHZ as diagnostic criteria to identify high risk children should be critically reviewed. Existing evidence and further analysis of existing data could be made available to the review process. (MAMI CHNRI research priority 1).
Pilot of breastfeeding interventions that target SAM infants <6m. Piloting the C-MAMI tool was specified as a top priority. This supports the proposed IBAMI research. (MAMI CHNRI research priorities 3, 4, 7).
There is a large gap in knowledge and associated interventions around maternal nutrition. In the context of MAMI, investigation of the impact of maternal supplementation when pregnant and when lactating is a priority. (MAMI CHNRI research priority 28, 29).
More funding for MAMI research is needed; researchers are encountering significant challenges in securing adequate resources.
Second level priorities identified were:
Update guidance and protocols, with specific reference to case definitions (MAMI CHNRI research priority 1).
Research into recovery and outcomes amongst treated infants <6m, including post-discharge (Research need not identified in MAMI CHNRI).
Research into risks and benefits of early complementary feeding in the context of SAM infants aged 4-5 months (WHO priority research question; MAMI CHRNI research priority 58).
Research into the role of social / cash/ non-food, psychosocial support interventions in MAMI (MAMI CHRNI research priorities 20, 43).
The meeting report is available online and presentations are available on request. For more information, contact: Marie McGrath, ENN. Visit our website for MAMI updates.
Since 2015, a ‘MAMI’ thematic area has been operating on en-net to support those working with this age group. Visit ENN to view and participate in discussions.
1 The MAMI Interest Group is an informal network of researchers and practitioners involved in the care of nutritionally vulnerable infants under 6 months and their carers, coordinated by ENN.
2 Angood C, McGrath M, Mehta S, Mwangome M, Lung’aho M, Roberfroid D, et al. (2015) Research Priorities to Improve the Management of Acute Malnutrition in Infants Aged Less Than Six Months (MAMI). PLoS Med 12(4): e1001812. doi:10.1371/journal.pmed.1001812
3 WHO, 2013. Updates on the management of severe acute malnutrition in infants and children. Guideline.
More like this
Resource: Meeting Report: Management of Acute Malnutrition in Infants under 6 months (MAMI) Interest Group Meeting
The meeting was co-hosted by ENN, London School of Hygiene and Tropical Medicine (LSHTM) and Save the Children as part of an ongoing collaboration on management of acute...
FEX: Making connections: Joint meeting of WaSt Technical Interest Group and MAMI Special Interest Group
ENN coordinates two international technical groups, the Management of at-risk Mothers and Infants under six months Special Interest Group (MAMI SIG) and the Wasting and...
FEX: Management of At risk Mothers and Infants (MAMI) meeting
A one-day meeting of the Management of At risk Mothers and Infants (MAMI)1 Special Interest Group (SIG) took place in London on 17 January 2018. The meeting was hosted by ENN...
FEX: Community management of uncomplicated malnourished infants under six months old: barriers to national policy change
By Sonja Read and Marie McGrath View this article as a pdf Sonja Read is a public health nutritionist and was lead researcher (ENN consultant) on the project. Marie McGrath...
FEX: MAMI-2 research prioritization – call for collaborators
In January 2010, the report of ‘The Management of Acute Malnutrition in Infants aged <6 months’ (the MAMI project)1 was released. Key findings included: Large numbers of...
FEX: The MAMI Project – Key findings and recommendations
Summary of report1 Child malnutrition is a major global public health issue. The burden of acute malnutrition in children 6 months to 5 years is well recognised, and the...
Management of Acute Malnutrition in Infants under 6 months (MAMI)
Turning challenges into opportunity: Moving forward. A one day meeting of interested practitioners and experts. London, 7th December, 2013 Date: 7th December, 2013 Venue:...
FEX: Improving community management of uncomplicated acute malnutrition in infants under six months (C-MAMI): Developing a checklist version of the C-MAMI tool
Summary of MSc project report1 By Sonja Read Sonja Read is a public health nutritionist from the London School of Hygiene and Tropical Medicine. She has previously worked in...
FEX: Perceptions of SAM treatment in infants under 6 months in Malawi
By Concetta Brugaletta Concetta Brugaletta is a clinical research nurse working in neurology. Currently based in the UK, she is interested in infant malnutrition and holds a...
FEX: Piloting the C-MAMI approach in the Rohingya response in Bangladesh
By Anne Marie Kueter, Alice Burrell, Sarah Butler, Mostofa Sarwar and Habibur Rahaman View this article as a pdf Anne Marie is a nutritionist with over five years'...
FEX: Methods to detect cases of severely malnourished infants under six months
Summary of research1 Location: Global What we know: The World Health Organization (WHO) recommends weight-for-length z score (WLZ) as an anthropometric indicator to identify...
MAMI Evidence There are a range of ongoing research activities by the MAMI Global Network and its partners. See below for a list of peer-reviewed publications. Upcoming...
FEX: Management of acute malnutrition in infants less than six months in a South Sudanese refugee population in Ethiopia
By Mary T Murphy, Kassahun Abebe, Sinead O'Mahony, Hatty Barthorp & Chris Andert View this article as a pdf Lisez cet article en français ici Sinead O'Mahony is a...
FEX: Management of At-risk Mothers and Infants under six months (MAMI): Update and direction
View this article as a pdf Summary of meeting report1 A two-day meeting of the MAMI Special Interest Group (SIG)2 was held on 12-13 December 2019, organised by Emergency...
Resource: Research Priorities to Improve the Management of Acute Malnutrition in Infants Aged Less Than Six Months (MAMI)
Summary points for this study: Worldwide, 8.5 million infants aged less than 6 months (<6m) are acutely malnourished. For the first time, 2013 WHO Malnutrition Guidelines...
FEX: Qualitative study of supplementary suckling as a treatment for SAM in Infants
This article summarises key findings of an MSc thesis1 By Natasha Lelijveld Natasha Lelijveld has recently completed her MSc in International Child Health at UCL. She is...
Resource: Meeting Report: Management of At risk Mothers and Infants under six months (MAMI) Special Interest Group (SIG) meeting
A one-day meeting of the Management of At risk Mothers and Infants under six months (MAMI) Special Interest Group (SIG) was hosted by ENN in collaboration with the London...
MAMI News and Events
MAMI News If you would like to receive MAMI Global Network's monthly updates please subscribe here. Past issues of the newsletter can be viewed here. If you would like to...
FEX: Risk factors for severe acute malnutrition in infants <6 months old in semi-urban Bangladesh: A prospective cohort study to inform future assessment/treatment tools
Summary of conference abstract1 Presented at the ACF research conference, November 9th, 2016. By M Munirul Islam, Yasir Arafat, Nicki Connell, Golam Mothabbir, Marie...
FEX: Revised CMAM Training Guide
The Food and Nutrition Technical Assistance III Project (FANTA), in collaboration with partners (Action Against Hunger, Alliance for International Medical Action (ALIMA),...
Reference this page
MAMI Interest Group meeting. Field Exchange 52, June 2016. p82. www.ennonline.net/fex/52/mamiinterestgroupmeeting