Menu ENN Search

State of the Evidence 2021-Modifications Aiming to Optimize Acute Malnutrition Management in Children under Five

Author: Action Against Hunger US
Year: 2021
Resource type: Report

Acute malnutrition impacts almost 50 million children under five each year (1), with the COVID-19 pandemic putting an additional 6.7 million children at risk (2). Children suffering from acute malnutrition are at significantly higher risk of morbidity and mortality (3,4). Community-based management of acute malnutrition (CMAM) has brought malnutrition treatment closer to home, increasing both coverage and access with high levels of effectiveness compared to inpatient, facility-based treatment. However, challenges remain in meeting the needs of all acutely malnourished children worldwide. For example, less than 20% of children with severe acute malnutrition (SAM) have access to treatment (5).

To address these challenges, organizations and governments have implemented “simplified approaches”, which Action Against Hunger USA defines as: a range of modifications and innovations to standard CMAM protocols with the aim of simplifying and streamlining operations, maximizing coverage, reducing overall costs, and optimizing cost-effectiveness. Furthermore, the COVID-19 pandemic presented unparalleled challenges to service continuity in the management of acute malnutrition, reducing children’s access to treatment. Addressing these concerns drove further implementation of these modifications and innovations, led by UNICEF and Global Nutrition Cluster guidance (6,7).

While many innovations have been tested to optimize CMAM service delivery, this summary focuses on those six modifications included in the global operational guidance on management of acute malnutrition in children aged 6-59 months in the context of COVID-19. 1 These six CMAM protocol modifications – often discussed under the umbrella of “simplified approaches” – include:

  1. Family MUAC
  2. Reduced frequency of follow-up visits during treatment
  3. Modified admission and discharge criteria to treatment programs
  4. Combined treatment/protocol of MAM and SAM
  5. Modified (or reduced) dosage of therapeutic or supplementary foods during treatment 
  6. Acute malnutrition treatment by community health workers (CHWs)

This summary assesses the current state of evidence on each approach in tabular form, providing: the definition and objectives; evidence of effectiveness; operational considerations (e.g., training, staffing, and logistics); cost considerations and evidence on cost-effectiveness; operational successes and challenges; and areas for future research and learning. This document is not intended to endorse any particular approach. Rather, it aims to objectively present the state of the existing evidence on each approach, so as to inform decision-making among practitioners looking to further test, refine and implement such approaches. The initial search was conducted in December 2020, with a follow-up search conducted in August 2021.

Further resources can be found at: https://acutemalnutrition.org/en and https://www.simplifiedapproaches.org

Download

ACF-US_State-of-the-Evidence-2021.pdf (PDF, 931kb)

More like this

Resource: State of the Evidence 2021-Modifications Aiming to Optimize Acute Malnutrition Management in Children under Five

Acute malnutrition impacts almost 50 million children under five each year (1), with the COVID-19 pandemic putting an additional 6.7 million children at risk (2). Children...

FEX: State of the evidence: Simplified approaches

View this article as a pdf Action Against Hunger USA. (2021). State of the Evidence 2021: Modifications Aiming to Optimize Acute Malnutrition Treatment in Children Under Five....

FEX: Landscape analysis of simplified approaches to community-based management of acute malnutrition in the East and Southern Africa Region (ESAR)

View this article as a pdf This is a summary of the following report: https://www.simplifiedapproaches.org/_files/ugd/2bbe40_280957e3883a4b9a8bd2be47bb047998.pdf By Michele...

FEX: Regional perspectives on simplified approaches for the management of children with acute malnutrition: West and Central Africa

View this article as a pdf Lisez cet article en français ici By Sophie Woodhead, Dolores Rio and Noel Zagre Sophie Woodhead is a Nutrition Specialist with UNICEF in...

FEX: Community health worker-led treatment for uncomplicated wasting: insights from the RISE study

View this article as a pdf Lisez cet article en français ici By Bethany Marron on behalf of the RISE study consortium Bethany Marron is a nutrition advisor and former...

FEX: Adaptations to community-based acute malnutrition treatment during the COVID-19 pandemic

View this article as a pdf Lisez cet article en français ici By Maria Wrabel, Sarah King and Heather Stobaugh Maria Wrabel is CMAM Adaptations Project Officer with...

FEX: Simplified approaches for the treatment of child wasting: A rapid evidence review

View this article as a pdf Report summary1 By Emilie Buttarelli, Grace Funnell and Sophie Woodhead Dr Emilie Buttarelli is a bio-cultural anthropologist currently working...

FEX: Simplified approaches website

View this article as a pdf Wasted children are up to 11 times more likely to die than those who are well nourished and currently treatment services only reach a third of...

FEX: Bangladesh: The rationalisation of nutrition services in Rohingya camps

View this article as a pdf Bakhodir Rahimov is a Nutrition Sector Coordinator in Cox's Bazar, Bangladesh working with UNICEF Abid Hasan is an Information Management Officer...

FEX: Bangladesh: The rationalisation of nutrition services in Rohingya camps

View this article as a pdf This article outlines the provision of nutrition services in Cox's Bazar, an area where multiple partners work together to deliver to those in need...

FEX: Community health worker-led treatment for uncomplicated wasting: insights from the RISE study

This is a summary of a Field Exchange field article that was included in issue 64. The original article was authored by Bethany Marron on behalf of the RISE study...

FEX: Adaptations to community-based acute malnutrition treatment during the COVID-19 pandemic

This is a summary of a Field Exchange field article that was included in issue 64. The original article was authored by Maria Wrabel, Sarah King and Heather Stobaugh Maria...

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...

FEX: COVID-19 adaptations to outpatient nutrition programmes in East Africa

View this article as a pdf This is a summary of the following paper: Shragai T, Talley L, Summers A et al (2022) Outcomes after Acute Malnutrition Program Adaptations to...

Resource: Simplified approaches to the treatment of wasting. Technical Brief.

This Technical Brief describes simplified approaches to wasting treatment which aim is to achieve greater coverage and improved efficiency of services while maintaining quality...

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...

en-net: Simplified Approaches in the context of COVID 19 (questions escalated to the GTAM Wasting TWG)

a. What can we do to quickly communicate that this [simplified approaches] is an acceptable adaptation to make in the circumstances to enable governments to make this...

FEX: Report on innovations in CMAM

By Anne Marie Kueter, Claudine Prudhon, Emily Keane and Megan Gayford The implementation of community-based management of acute malnutrition (CMAM) as the standard model of...

FEX: Family MUAC: A review of evidence and practice

View this article as a pdf Summary of research1 By Emilie Buttarelli, Sophie Woodhead and Dolores Rio Dr Emilie Buttarelli is a bio-cultural anthropologist (Health Science,...

FEX: Cost-efficiency of a simplified protocol for wasting treatment in Mali

View this article as a pdf Lisez cet article en français ici Derek Lee is a Best Use of Resources Advisor for Nutrition at International Rescue Committee...

Close

Reference this page

Action Against Hunger US (2021). State of the Evidence 2021-Modifications Aiming to Optimize Acute Malnutrition Management in Children under Five. www.ennonline.net/stateoftheevidence2021aah

(ENN_7181)

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.