1 / 41

MAM Decision-making Tool

MAM Decision-making Tool. Meeting Objectives. Review the MAM decision-making tool Work through country situation Provide feedback on Content Usability Layout. Moderate Acute Malnutrition (MAM). Background Review of supplementary feeding programs (2007)

bijan
Download Presentation

MAM Decision-making Tool

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MAM Decision-making Tool

  2. Meeting Objectives • Review the MAM decision-making tool • Work through country situation • Provide feedback on • Content • Usability • Layout

  3. Moderate Acute Malnutrition (MAM) Background • Review of supplementary feeding programs (2007) • WHO consultations MMI (2008) and MMII (2010) • Dietary needs • Programme approaches to manage MAM • NUGAG review on MAM • Limited guidance on programming • Differing approaches • Increase in products available for programming CONFUSION!!!

  4. Moderate Acute Malnutrition (MAM) • Burden of MAM • 11 million children affected globally • 41 million children • 3 x risk of death compared to well-nourished • Increased risk of acute malnutrition in emergencies

  5. MAM Taskforce Additional Members WHO ECHO • Formed by the Global Nutrition Cluster • UNHCR • UNICEF • WFP • OFDA • ACF • Save the Children • CDC

  6. Tool Objectives Decision making process grounded by data, but is subjective on some levels • Guide practitioners to identify most appropriate and feasible strategies to address MAM • Prevention • Management (treatment) • Harmonize nutrition programme decision-making on MAM in emergency situations • Incorporate contextual situational factors into the decision making process • Beyond nutritional status • Engage in discussion

  7. Caveats of Tool • Limited to emergency contexts • Rapid/sudden onset • Slow onset • Protracted emergencies • Acute emergency within a chronic emergency setting • Local or large-scale emergencies • Not for refugee contexts • UNHCR/WFP Guidelines for Selective Feeding: The Management of Malnutrition in Emergencies 2011 http://www.unhcr.org/4b7421fd20.pdf

  8. Caveats of Tool • Primary objective: prevent morbidity and mortality associated with MAM • Linkages: MAM cannot be addressed in isolation • SAM • IYCF-E • Other sectors (WASH, health, food security) • Re-assessment

  9. MAM decision tool steps Prevention/treatment Prevention Treatment No additional programme Step 1: Programme Type/Objective Step 2: Modality Supplementary feeding Cash/voucher Infant and Young Child Feeding Target group Product Duration Delivery Step 3: Programme Operation Step 4: Review and Revise Regularly throughout the emergency

  10. Data Needs • Prevalence of GAM in the affected area (current or historical) • Information nature and severity of the crisis (risk) • Baseline health data in affected areas • Expected impact on morbidity • Food security situation • Expected impact on food security • Population data • Displacement • Density

  11. Nutritional Data MAG scenarios for the tool • High >15% • Medium 8-15% • Low <8% Sources • Trend data • Seasonality • Admission data (coverage should be assessed) • Screening data

  12. Risk of Deterioration

  13. Morbidity • Malnutrition Infection Cycle • Likelihood of morbidity and/or outbreak to impact GAM • Baseline data • Vaccination coverage, vitamin A coverage, disease profile • WASH services • Access to care

  14. Food Security Magnitude, extent, severity and duration of the crisis on food security Household consumption and market data sources

  15. Displacement • Influences type and frequency of programme • Many different contexts and types of displacement • Dispersed settlements, mass shelter in collective centers, reception and transit camps, self settled camps, planned camps (official and unofficial), IDPs with host populations

  16. Population Density • Risk of morbidity • Consider in programme delivery design • Example: low GAM, but high density= large number of children in need • Haiti, post earthquake in Port au Prince • Kenya, post election violence in urban centers

  17. Risk of Deterioration

  18. Programme Recommendations

  19. MAM decision tool steps Prevention/treatment Prevention Treatment No additional programme Step 1: Programme Type/Objective Step 2: Modality Supplementary feeding Cash/voucher Infant and Young Child Feeding Target group Product Duration Delivery Step 3: Programme Operation Step 4: Review and Revise Regularly throughout the emergency

  20. Prevention: Modality Infant & Young Child Feeding in Emergencies Component IYCF-E support Blanket Supplementary Feeding • Provision of supplementary food • Platform for other interventions • Screenings + referrals • Child survival (deworming, vit A, immunisation) • Health/nutrition education Cash or Voucher • Cash/voucher if food and nutrient availability is good, markets functioning, caring practices maintained • Further research needed • Specialised product + cash • Cash 4X value of specialised product

  21. Prevention: Target Group BSFP should not be expanded to beyond 6-59 months and PLW except under serious conditions The general food distribution (GFD) should meet the needs of other household members. Advocacy for improving the GFD or other food security measures. • Children under 5 at increased risk mortality • Target children 6-59 months • If logistical constraints consider reducing target group • PLW • No standard criteria for enrollment • Impact on IYCF-E • MAM treatment programming exist • Low birth weight • Prioritise • children over PLW • lactating over pregnant women (protecting 0-6 month old infants)

  22. Prevention: Product Considerations • Government approval • Objective of the intervention & target group • Some products are targeted for 6-23/36 months • Household’s ability to cook • Are there cooking facilities, easy access to fuel and water? • Cultural practices and food preferences • Corn, wheat & rice based supercereals • RUFs- peanut, chickpea and milk based (limited quantities) • Nutrient gap (energy & micronutrient) • Decide upon higher or lower level energy • HH food security, diet diversity, baseline diets, chronic malnutrition, micronutrient deficiencies • Sharing practices, household use of foods, access to other foods

  23. Product SheetNutrition Specialised Products

  24. Product SheetNutrition Specialised Products

  25. Recommended Products and Alternatives ± Only where supplement is the primary source of available food

  26. Prevention: Duration and Exit Strategy • Duration of BSFP based on scale & severity of emergency • GAM + Risk of deterioration • Generally 3-6 months • Example start at least 1 month prior to leans season and run until post-harvest • Regular re-assessment • Scaling up or down • Extension • Rolling admission and no discharge (exiting) until end of programme (even if child is older than upper limit at the close of programme)

  27. Prevention: Delivery Mechanism Considerations • Access to the population • Security, seasonal, physical • Scale of crisis (total area affected) • Implementation capacity • Low or security- consider combining with GFD • Population density • Determine number of sites • If dense, may need multiple days/week for distribution

  28. Prevention: Delivery Mechanism BSFP stand alone programme • Targeted directly to households with children BSFP Integrated delivery • Child’s supplementary food is added to food/cash/voucher distribution • Low security context • Rapid onset immediate programming • Exclusion and inclusion errors • Shift to parallel independent programme as soon as feasible

  29. Treatment • Targeted Supplementary Feeding (TSFP) • Treatment for MAM with nutritious food supplement and routine medical care • Admission/discharge criteria based on anthropometric measures (national or international guidelines) • Nutrition communication • Support for IYCF-E Cash/vouchers need more evidence

  30. Treatment: Target Group Malnourished children 6-59 months Discharges from SAM Pregnant and lactating (up to 6 months postpartum) women Chronic illness (HIV, TB) Exceptions Infants <6 months not admitted, support IYCF strengthened Other vulnerable populations identified (disabled children , 5-10 years olds, older people)

  31. Treatment: Product Considerations • Government approval • Target group • Household’s ability to cook • Are there cooking facilities, easy access to fuel and water? • Cultural practices and food preferences • Corn, wheat & rice based supercereals • RUFs- peanut, chickpea and milk based (limited quantities)

  32. Product SheetNutrition Specialised Products

  33. Recommended Products and Alternatives ± Only where supplement is the primary source of available food

  34. Treatment: Duration and Exit Strategy • Treatment range 1-4 months • Scale down of TSFP considered when: • GAM <5% • No aggravating factors • Low numbers of admissions in MAM and SAM treatment may also be used to decide to phase out • Be mindful of programme coverage and performance

  35. Treatment: Delivery Mechanism Considerations • Access to the population • Security, seasonal, physical • Scale of crisis (total area affected) • Implementation capacity • Low or security- consider combining with GFD • Population density • Determine number of sites • If dense, may need multiple days/week for distribution

  36. Treatment: Delivery Mechanism • Linked closely to treatment of SAM under CMAM model • TSFP sites adjacent to OTP or health centres support referrals (both directions) • Large area for distribution/services • If mobile or away from health centres provide basic health interventions • Considerations • Health service coverage, existing MAM/SAM programmes, capacity to scale-up

  37. Prevention &Treatment • Both prevention and treatment may be recommended • Follow the previous steps to design each programme • Think through linkages between programmes • Ideally, children should not be simultaneously enrolled in both programmes • In reality, the risks associated with non-participation outweigh the cost of dual participation • In some large emergencies children should be enrolled in prevention programmes as they may come in and out of treatment • Example: Northern Kenya, 2011/12

  38. No Additional Intervention Emergency programming is in addition to existing nutrition programmes • Additional programs not needed • Existing nutritional programs • Re-evaluate risk as emergency progresses • Build into nutrition response plan • Strengthen support for IYCF or micronutrient programmes

  39. MAM decision tool steps Prevention/treatment Prevention Treatment No additional programme Step 1: Programme Type/Objective Step 2: Modality Supplementary feeding Cash/voucher Infant and Young Child Feeding Target group Product Duration Delivery Step 3: Programme Operation Step 4: Review and Revise Regularly throughout the emergency

  40. Programme Linkages Interventions in emergencies: Addressing acute malnutrition Selective feeding programmes General Food Distribution IYCF-E MAM Programmes Treatment for SAM Addressing underlying causes of undernutrition Prevention Blanket feeding Cash/voucher Outpatient treatment WASH Food security Health Treatment Targeted Inpatient treatment Addressing micronutrient deficiencies

  41. Additional Feedback • Josephine Ippe: Global Nutrition Cluster jippe@unicef.org • Lynnda Kiess: World Food Programme lynnda.kiess@wfp.org My contact: Leisel Talley, Centers for Disease Control and Prevention: Ltalley@cdc.gov

More Related