Menu ENN Search

Updating national community-based management of acute malnutrition guidelines: Lessons from previous experiences

This is a summary of the following report: GNC Technical Alliance Wasting thematic working group & Carr S (2022) Updating national CMAM guidelines: Lessons from previous experiences. https://www.ennonline.net/updatingnationalcmamguidelines2022

The World Health Organization (WHO) is currently updating guidelines for the prevention and treatment of child wasting – ready for release in 2023. To impact practice on the ground, these new WHO guidelines will need to be translated into national guidelines. This report, undertaken by a sub-group within the Global Nutrition Cluster Technical Alliance ‘Wasting’ thematic working group, explores the past experiences from a diverse range of countries on developing and/or updating their current wasting guidelines to better inform the upcoming processes. In total, 20 key informant interviews were conducted representing seven different countries. A comprehensive national community-based management of acute malnutrition (CMAM) guideline ‘mapping matrix’ was also developed to summarise current guideline status for 95 countries, including the year they were last updated and any plans for upcoming revisions.

The study found that the process used for developing and updating CMAM guidelines varied greatly across the seven countries. The overall time for the original development of guidelines ranged from eight to 18 months and updates took anywhere from around two to 24 months. The stakeholders involved in the process included relevant United Nations agencies, local and international non-governmental organisations, foundations, donors, governments, professionals, and academics.  Representation from civil society and communities was absent in most countries, contradicting their importance in the governance of primary healthcare. The cost of developing and updating CMAM guidelines was largely unknown although many felt it was both costly and time demanding.

Countries were predominantly motivated to update their guidelines to align with the WHO guidance and to account for local contextual challenges and differences. The most common barriers that countries faced in this process were funding and stakeholder consensus, and the most common facilitating factors included Ministry of Health leadership and commitment and an active nutrition working group as well as stakeholder commitment and availability. Most countries interviewed were aware that a WHO update is imminent, with many key informants learning of the update through word of mouth rather than official notifications. When countries were asked if they had plans to update their CMAM guidelines following the new WHO revision, two countries responded by saying that they had just completed updating their guidelines and they would need to consider what the updates were and how they would translate to their contexts. Two countries were actively awaiting the new guidelines ahead of making any updates.

Key informants identified the following needs in order to support the guideline updates: technical nutrition support; financial support; human resource support; capacity building for health workers; support from an external consultant; support from guideline training packages and material; support with rolling out guideline implementation, including the creation of training materials for frontline health workers on any new aspects of the guidelines; and support from the WHO to get started, including the provision of a roadmap and budget template, and a summary of what is new in the latest update.

Based on these findings, the report makes 14 recommendations, aimed at national governments, relevant United Nations agencies, and supporting civil society organisations. The report concludes that the lessons learned, and recommendations generated, should help future guideline update processes. Efficiently rolling out the new WHO guideline updates into practice is considered to be another opportunity to support the reduction in children suffering from wasting to <3% by 2030.

More like this

Resource: Updating National CMAM Guidelines Lessons from Previous Experiences

This paper, produced under the Wasting Global Thematic Working Group within the GNC Technical Alliance as a result of an identified need, explores the past experiences of...

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: Management of SAM in the Philippines: from emergency-focused modelling to national policy and government scale-up

By Aashima Garg, Anthony Calibo, Rene Galera, Andrew Bucu, Rosalia Paje and Willibald Zeck Lisez cet article en français ici Aashima Garg is Nutrition Specialist based...

en-net: Prevention and Treatment of moderate acute malnutrition

Nepal has been implementing CMAM as a pilot project in five districts. In CMAM project, there is no supplementary feeding to prevent and treat moderate acute malnutrition. We...

Video: ENN hosted Webinar on WHO Wasting Guidelines and Development

In light of the upcoming update to the WHO guidelines for the management of wasting, this webinar was hosted to improve understanding of the WHO guideline development process...

FEX: Ready-to-use therapeutic food and the WHO list of essential medicines

By Aurélie du Châtelet, Anne-Dominique Israel, Elise Rodriguez, Wisdom Dube, Laetitia Battisti, Magali Garcia, Coline Morin and Natalie Sessions. Aurélie...

en-net: What should be the nutritional support to adult patients with Ebola Virus Disease (EVD) in treatment centres in West Africa?

Dear experts, I would appreciate your help in this. I drafted the following text but you might have ideas and other suggestions. Please help me on this one... This question...

FEX: Tech RRT CMAM Adviser: Experiences from Nigeria and Yemen

By Simon Kiarie Karanja View this article as a pdf Simon Karanja is a nutritionist with over ten years' experience in nutrition in emergencies, holding various positions in...

en-net: NEW Updates on Breastfeeding, Infant Feeding, Breast Milk and COVID-19 – excerpts from scientific journal articles –  30 December 2020

Dear Colleagues, We have updated our special repository on Breastfeeding, Infant Feeding, Breast Milk and COVID-19. Since our last update Friday 18 December 2020, we have...

FEX: Implementing the IMAM Surge approach - experiences from Kenya

View this article as a pdf By Weldon Ngetich, Grace Gichohi, Francis Wambua, Tewoldeberhan Daniel, Yacob Yishak and Patrick Codjia Weldon Ngetich is a Nutrition Specialist...

Resource: Scale-up of severe wasting management within the health system: A stakeholder perspective on current progress

Executive summary Introduction Wasting is a critical issue for child survival and development, with therapeutic treatment of severe cases recognised as an essential...

FEX: CMAM Surge: lessons learned on the journey so far

View this article as a pdf By Erin McCloskey, Amanda Yourchuck and Peter Hailey Erin McCloskey is a Public Health Nutritionist and independent consultant currently working...

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: Community-based management of acute malnutrition (CMAM) Conference 2021

View this article as a pdf Concern Worldwide and Irish Aid hosted a virtual conference on the community-based management of acute malnutrition (CMAM) in March 2021. The...

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...

Video: Update webinar on the WHO Wasting Guideline Development Process

The process for developing the WHO guidelines for the prevention and treatment of wasting is well underway. Since the last webinar on the process in September 2020 much has...

FEX: Summary of the development process for the guideline on the prevention and treatment of wasting

View this article as a pdf Background The World Health Organization (WHO), in collaboration with UNICEF, the United Nations High Commissioner for Refugees (UNHCR), the Food...

FEX: Integration of management of children with severe acute malnutrition in paediatric inpatient facilities in India

View this article as a pdf Lisez cet article en français ici By Praveen Kumar, Virendra Kumar, Sila Deb, Arpita Pal, Keya Chatterjee, Rajesh Kumar Sinha and Sanjay...

FEX: 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...

FEX: FEX 65 editorial themes

View this article as a pdf Dear readers, A warm welcome to the 65th edition of Field Exchange. This edition features a range of programming issues that unfortunately reflect...

Close

Reference this page

Updating national community-based management of acute malnutrition guidelines: Lessons from previous experiences. Field Exchange 68 , November 2022. www.ennonline.net/fex/68/nationalwastingguidelinesmapping

(ENN_7521)

Close

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.