Management of At Risk Mothers and Infants (MAMI)
Donors: Irish Aid
Collaborators: LSHTM, University of Washington, KEMRI-Wellcome Trust Project and CHAIN (Kenya), WHO, UNHCR, UNICEF, Save the Children, ACF, Goal, MSF, World Vision, Partners in Health, Integrowth/Interpractice, and independent experts and practitioners.
ENN project lead and contact: Marie McGrath
Timeframe: 2008 - ongoing
Management of At risk Mothers and Infants (MAMI) concerns the identification and care of at risk infants under 6 months and their mothers, with particular interest in nutrition vulnerability.
Our vision is that every infant under six months of age, at every community and health-service contact, is nutritionally assessed and appropriately supported to survive and thrive.
ENN begain working on the Management of Acute Malnutrition in Infants under 6 months (MAMI) project in 2008 prompted by challenges shared by NGOs in emergency contexts. This led to a two year ENN-led collaboration with University College London (UCL) and Action Against Hunger to examine the burden of acute malnutrition in this age group, investigate case management in emergency programmes, and assess guidance and tools available to inform programmers. Published findings highlighted a high burden of wasting in infants under six months globally, and higher mortality in this age group in emergency programmes.
A MAMI Special Interest Group (SIG) was formed, coordinated by ENN, to help address the gaps in guidance and evidence. This group now comprises 36+ practitioners and researchers involved in MAMI policy, research and programming worldwide, and works to harmonise and collaborate on policy, research & programming.
This project is founded on very strong partnerships with creative, intuitive, pragmatic academics and direct engagement with programmers working with these infants. ENN collaborates closely with leads at the London School of Hygiene and Tropical Medicine (LSHTM) Marko Kerac) and Save the Children US (Nicki Connell), in addition to researchers at the KEMRI-Wellcome Trust Project (Kenya); NGOs including Save the Children, GOAL, ACF, MSF, World Vision and Partners in Health; UN agencies (UNICEF, WHO, UNHCR, WFP) and independent experts and practitioners.
The MAMI SIG has been successful to date in:
- Supporting normative policy guidance change: Through advocacy and engagment of group members, community based management of uncomplicated cases of acute malnutrition in infants under 6 months (C-MAMI) is now recommended in the WHO 2013 update of SAM guidance.
- Developing tools to put policy into practice: The C-MAMI tool was developed through peer review consultation and is now being used and trialled in Bangladesh (Save the Children), Ethiopia (GOAL) and Rwanda (Partners in Health).
- Building the evidence base on assessment of at risk infants under 6 months: Flagship research by KEMRI-Wellcome Trust Project (Kenya) includes a review of the application of anthropometric indicators in the identification of severe acute malnutrition (SAM) in infants under 6 months, and a secondary data analysis aound maternal and infant risk factors for SAM.
- Stop-gapping guidance for critical programme questions: A review of micronutrient supplementation, antibiotics and deworming in treatment of malnourished infants under 6 months is now being finalised, to address programmer questions in the face of low direct evidence.
ENN is a member of the Council of Research and Technical Advice on Acute Malnutrition (CORTASAM) of the No Wasted Lives Initiative, representing a MAMI interest.
ENN is technical advisor on MAMI research led by Save the Children in Bangladesh to investigate the burden of acute malnutrition in infants under six months and explore perceptions of caregivers and health workers regarding community based treatment options (submitted for peer review publication). A new phase in 2018 is piloting the C-MAMI tool in Bangladesh; an evaluation is currently underway (results in April 2018).
On 17th January 2018, ENN hosted a meeting of the MAMI SIG in Oxford, funded by Irish Aid and Save the Children. This immediately followed a combined meeting of the MAMI SIG and Wasting and Stunting Technical Interest Group on the 16th January, to identify synergies. The MAMI meeting report is available here.
MAMI research, reviews and resources
- A review of anthropometric indicators to assess acute malnutrition in infants under six months
- An updated review of MAMI content of national acute malnutrition treatment guidelines
- Three country case studies to examine barriers to national policy guidance uptake on MAMI
- Cohort data analysis to investigate utility of anthropometric indicators to predict mortality in first year of life.
- Review of non-feeding interventions (micronutrient supplementation, antibiotics, deworming) for management of acute malnutrition in infants under 6 months.
- Secondary data analysis to explore infant, maternal and household factors associated with acute malnutrition in infants under six months.
C-MAMI tool - This is a short practical tool to support community-based management of uncomplicated cases of acute malnutrition in infants under six months of age (C-MAMI) that was developed by ENN, LSHTM, Save the Children US and collaborators in 2015. The aim was to provide a first step to case mangement to catalyse programming development, modelled on the Integrated Management of Childhood Illness (IMCI) framework. Version 1.0 of the tool and a brief checklist is available here. Small scale pilots are underway in Bangladesh (Save the Children), Ethiopia (GOAL) and Rwanda (Partners in Health) with prospects in Kenya and Philippines mid-2018.
Peer reviewed publications
Perceptions of acute malnutrition and its management in infants under six months of age: a qualitative study in rural Bangladesh" in its current form for publication in Clinical Medicine Insights: Pediatrics. Accepted for publication (Feb 2018).
Kerac M, Blencowe H, Grijalva-Eternod C, et al 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. Archives of Disease in Childhood 2011;96:1008-1013.
Grijalva-Eternod, C.S., Kerac, M., McGrath, M., Wikinson, C., Hirsch, J.C., Delchevalerie, P. and Seal, A.J. (2016) Admission profile and discharge outcomes for infants aged less than 6 months admitted to inpatient therapeutic care in 10 countries. A secondary data analysis. Matern Child Nutr. 2016 Jul 25, doi: 10.1111/mcn.12345.
A review of methods to detect cases of severely malnourished infants less than 6 months for their admission into therapeutic care by ENN, 2017.The Childhood Acute Illness and Nutrition Network and LSHTM.
Islam MM, Arafat Y, Connell N, Mothabbir, McGrath M, Berkley JA, Ahmed T, Kerac M (2018). Prevalence, risk factors and outcomes of severe acute malnutrition among infants aged <6 months in Bangladesh: repeat cross sectional surveys and a prospective cohort study. Submitted for publication.
Kerac M, Frison S, Connell N, Page B, McGrath, M (2018). Informing the Management of Acute Malnutrition in Infants aged <6 months: risk factor analysis using nationally-representative Demographic & Health Survey secondary data. Pending resubmission for publication. Presented at Nutrition & Growth Meeting, Amsterdam, March 2017
Mwangome M, Moses Ngari M, Kerac M, Kabore P, PhD thesis author, Bawhere P, McGrath M and Berkley JA. Mid upper arm circumference at birth and at age of routine vaccination to predict mortality in the first year of life: a retrospective birth cohort study in Bukina Faso. Being finalized for publication in 2018.
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Reference this page
Marie McGrath (2016). Management of At Risk Mothers and Infants (MAMI). www.ennonline.net/ourwork/research/mami