Menu ENN Search


View this article as a pdf 

Apart from the thematic focus on MAMI1 in this 58th issue of Field Exchange (see dedicated editorial that introduces the section on page 50) we have a very diverse set of field articles and research. Rather than try to identify common threads between articles, we decided simply to highlight some of the most significant findings. Without wishing to over-sensationalise them, we thought the following might stimulate some interest:

Do families really ever starve their children to get or maintain access to programmes?

A study from South Sudan by Natalie Sessions and Regine Kopplow of Concern Worldwide found that mothers were indeed incentivised to keep children in treatment programmes for global acute malnutrition so that the family could have continued access to both the nutrition products and the general food distribution programmes (GFDs) available to families with malnourished children. There have been many anecdotal reports of this kind of behaviour where food stress has been severe, but this is one of the only studies we are aware of that has employed multiple focus group discussions and key informant interviews to highlight the problem. 

At a global level, what percentage of household food comes from market purchase?

A recent blog by the relatively new Executive Director of GAIN, Laurence Haddad, states that average households in nearly all countries in the world now acquire the majority of their food from markets, most of which are packaged foods, and the market for this is growing in middle-income countries (and probably also in low-income countries). Laurence optimistically concludes and elaborates on how this presents both a business and nutrition opportunity.

Do school feeding programmes ever have a measurable impact on nutrition?

Yes – according to an article by WFP on a school feeding programme in Niger. The programme provided daily meals for girls and boys in primary schools fortified using micronutrient powders, and weekly iron and folic acid supplements provided to secondary school girls and boys. The programme significantly reduced anaemia prevalence in primary school boys and girls and secondary school boys, but not in secondary school girls (likely due to higher needs). Nutrition knowledge, dietary diversity and consumption of iron-rich foods also improved. The proportion of girls passing the school year doubled. Scale-up is using a more intensive, girls-only supplementation protocol targeting the poorest at household level, not just through schools.

How much does a nutrition survey cost?

I tend to walk around with a figure  of £20,000 in my head. A recent UNICEF/Action Against Hunger review examined the implementation of SMART surveys across sub-Saharan Africa (45 countries) and the factors that have facilitated their institutionalisation.  Thirty-two countries had implemented SMART surveys. Average costs are US$21,100 (about £16,400; national surveys) and US$15,050 (about £11,700; small-scale surveys) – so I wasn’t that far off.

Is the disconnect between MAM and SAM programming still taking place in current emergencies?

We’re afraid it is. In this issue we have the example from Yemen. An article by Najwa Al-Dheeb, Anna Ziolkovska and Stanley Chitekwe (UNICEF) describes how community-based management of acute malnutrition (CMAM) programming, introduced in 2009, has evolved to meet increased caseload and now includes mobile teams, integration with vaccination and community health worker services, and increased geographical coverage. Progress is reflected in significant improvement in cure rates, defaulter rates and estimated number of deaths averted (over 221,669 deaths of children under five years old were averted between 2012 and 2017). However, management of acute malnutrition (MAM) treatment scale-up has not kept pace with severe acute malnutrition (SAM) treatment (48% versus 72% geographical coverage).

Misaligned scale-up between SAM and MAM is not unusual in the articles we feature in Field Exchange; SAM scale-up dominates. This is partly what has prompted us to embark on producing a special edition in 2019 which will capture experience and research that addresses the continuum of acute malnutrition care.

Are there any good examples of integration of CMAM into health systems?

Yes, and we have an article in this edition which makes a great case study of successful integration. In 2010 UNICEF supported integration of CMAM services (SAM treatment) into 75% of fixed health facilities in north-eastern Nigeria. In 2015 infant and young child feeding (IYCF) support and multiple-micronutrient powder (MNP) were added. Government has led scale-up of this integrated package; the number of centres has increased fourfold and the number of children treated has increased fivefold (2013-17). UNICEF’s role in scale-up has focused on supporting state government to meet immediate needs of severely malnourished children while strengthening the government health system. A minimum nutritional services package was finalised in early 2017).

We hope this short editorial has made you want to read further. Enjoy!

Jeremy Shoham

Co-Editor, Field Exchange

If you would like to write an article for Field Exchange, email Chloe Angood with ideas. We welcome contributions any time.



1Management of At risk Mothers and Infants under six months old

More like this

FEX: Results and lessons learned from WFP’s efforts to support adolescent girls in Niger

By Alexandra Pirola, Benedict Tabiojong Mbeng and Mica Jenkins View this article as a pdf Lisez cet article en français ici Benedict Tabiojong Mbeng is Head of...

FEX: Editorial

View this article as a pdf Dear Field Exchange readers, Welcome to the 64th edition of Field Exchange. We are delighted to kick start 2021 featuring a special section on...

FEX: Mainstreaming nutrition in a school-based feeding programme in northeast Nigeria

By Greg Sclama View this article as a pdf Lisez cet article en français ici Gregory Sclama is an Assistant Professor of International Development and Economics at the...

en-net: Probable reasons for a significantly higher rates of acute malnutrition in boys than girls

In a context where underweight, stunting is more than 50% we have significantly higher rates of wasting in boys than girls. other food security situation are as poor food...

en-net: CMAM admission by MUAC gender biased?

I am currently analysing OTP patient cards from Concern's CMAM pilot in Bardiya, Nepal and found the following: In total I have 1469 new admissions registered. According to...

FEX: Editorial

View this article as a pdf In this issue of Field Exchange we are delighted to feature, for the second year running, a special section that shares key outputs of Action...

en-net: Reaching out of school adolescents

Is there anyone implementing programming for out-of-school adolescents, and if so, what are they doing and are there any particular successes or challenges being faced? WFP...

FEX: OptiMA study in Burkina Faso: Emerging findings and additional insights

View this article as a pdf Lisez cet article en français ici By Kevin PQ Phelan Kevin PQ Phelan is Nutrition Advisor at ALIMA, the Alliance for International Medical...

FEX: Experiences of implementing CMAM in Yemen and number of deaths averted

By Najwa Al-Dheeb, Anna Ziolkovska and Stanley Chitekwe View this article as a pdf Lisez cet article en français ici Najwa Al-Dheeb is the Health and Nutrition...

FEX: Editorial

This issue of Field Exchange speaks largely to the themes of scaling up and integration of nutrition programming, as well as multi-sector approaches to addressing...

FEX: Assessment of adolescent girl nutrition, dietary practices and roles in Zimbabwe

Amelia Reese-Masterson and Pamela Murakwani Amelia Reese-Masterson has been with International Medical Corps since November 2011 as Research Advisor in the Nutrition, Food...

en-net: Design framework for CMAM programming

This question is edited from a discussion initiated by Victoria Sibson directly with the authors of the recent Field Exchange article "Suggested New Design Framework for CMAM...

FEX: How many lives do our CMAM programmes save? A sampling-based approach to estimating the number of deaths averted by the Nigerian CMAM programme

By Assaye Bulti (UNICEF), Stanley Chitekwe (UNICEF), Chloe Puett (ACF), and Mark Myatt (Brixton Health) Assaye Bulti is responsible for managing routine nutrition programme...

FEX: The cost of implementing the C-MAMI tool to treat nutritionally vulnerable infants in Bangladesh

By Natasha Lelijveld, Mostofa Sarwar, Golam Mothabbir, Sarah Butler and Nicki Connell View this article as a pdf Natasha Lelijveld is a Research Fellow at the Centre for...

FEX: Intergenerational cycle of acute malnutrition among IDPs in Somalia

By Samson Desie Samson Desie is a nutrition specialist who has worked in the sector for more than a decade and currently works as Nutrition Cluster Coordinator with UNICEF...

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: Food Preparation an Obstacle to Education

This article is written by Betty Kidan Muni who is a field officer working for SCF with women's groups in south Sudan*. Background Betty Kidan (author of the article)...

FEX: No Wasted Lives: Accelerating action for children with acute malnutrition

By Saul Guerrero, Nancy Aburto, Erin Body, Diane Holland, Guy Holloway, Abigail Perry and Sophie Whitney Saul Guerrero is the Director of International Nutrition Initiatives...

FEX: en-net update

By Tamsin Walters, en-net moderator Over the past three months (Nov 2016 to Jan 2017), 47 questions have been posted on en-net, generating 81 responses. The forum areas for...

FEX: Editorial

Dear readers, Following ENN's bumper issue of Field Exchange on the response to the Syria crisis (issue 48) this issue has reverted to our more normal non-thematic format...


Reference this page

Editorial. Field Exchange 58, September 2018. p1.



Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.