Management of At Risk Mothers and Infants (MAMI)
Donors: Irish Aid, Eleanor Crook Foundation (ECF)
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, ECF and independent experts and practitioners.
ENN project lead and contact: Marie McGrath
Timeframe: 2008 - ongoing
MAMI (Management of At risk Mothers and Infants under 6 months) concerns the identification and care of nutritionally at risk mothers and infants under 6 months.
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.
This is the home page for the soon to be launched MAMI Global Network (formerly the MAMI Special Interest Group), a network of programmers, researchers and policy-makers working to advocate for, strengthen evidence and improve practice to support at risk infants under six months and their mothers. The MAMI Global Network is coordinated by ENN, co-led by ENN and LSHTM.
This one hour presentation recording by Marie McGrath, ENN Technical Director shares key principles of the MAMI approach, how this collective effort has evolved, resources available to support practitioners and exciting potential looking ahead.
Statement on management of at-risk mothers and infants under six months (MAMI) in the context of COVID-19 issued by members of the MAMI Special Interest Group in collaboration with the Wasting Thematic Working Group of the Global Technical Assistance Mechanism for Nutrition (GTAM).
This short video developed by Save the Children in collaboration with the MAMI Global Network shares field experiences from Save the Children and GOAL of the MAMI approach in Bangladesh and Ethiopia.
Please note: C-MAMI Tool V2 is currently undergoing a collaborative update by the MAMI-SIG led by ENN. A pilot version will be released in August 2020 as the MAMI Care Pathway, a user-friendly package of tools to support each step in the identification and management of at-risk mothers and infants under six months. For more information, please contact Kelsey Grey at email@example.com.
Review of anthropometric indicators to assess acute malnutrition in infants under six months
MAMI thematic area, en-net
Background and Future
ENN began 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 (MAMI SIG) was formed, coordinated by ENN, to help address the gaps in guidance and evidence. This group comprises around 50 practitioners and researchers across UN agencies, NGOs, academic institutions and independents involved in MAMI policy, research and programming worldwide, and works to harmonise and collaborate on policy, research & programming.
This initiative was founded on very strong partnerships with creative, intuitive, pragmatic academics and direct engagement with programmers working with these infants. ENN co-leads the MAMI SIG with London School of Hygiene and Tropical Medicine (LSHTM) Marko Kerac), steered by experienced practitioners/researchers at Save the Children, GOAL, MSF, KEMRI-Wellcome Trust Project (Kenya).
In mid-2020, the ENN secured funding support from the Eleanor Crook Foundation to scale up the MAMI SIG into a MAMI Global Network. Watch this space for more news on this exciting new phase on MAMI.
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 by programmers. Version 2.0 (2018) is now available.
- 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.
On 17th January 2018, ENN hosted a meeting of the MAMI SIG in Oxford, funded by Irish Aid and Save the Children. The MAMI meeting report is available here. 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 WaSt meeting report is available here.
MAMI research, reviews and resources
- MAMI RISE research Ethiopia
- 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.
A special section on MAMI featured in Field Exchange issue 58 (September, 2018) which included articles on the Rohingya response in Bangladesh, follow up of particularly vulnerable infants in Rwanda and news of the updated C-MAMI tool, among other articles.
Wasting and COVID-19 Programme Adaptations Information Note 005 produced by the Wasting Thematic Working Group of the Global Technical Assistance Mechanism for Nutrition (GTAM) with the support of MAMI Special Interest Group.
Peer reviewed publications
Martha Mwangome, Moses Ngari, Paluku Bwahere, Patrick Kabore, Marie McGrath, Marko Kerac, James A. Berkley (2018). Anthropometry at birth and at age of routine vaccination to predict mortality in the first year of life: A birth cohort study in Burkina Faso
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: A prospective cohort study.
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.
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Reference this page
Marie McGrath (2016). Management of At Risk Mothers and Infants (MAMI). www.ennonline.net/ourwork/research/mami