Management of Acute Malnutrition in Infants (MAMI)

A retrospective review of the current field management of moderately and severely malnourished infants under six months of age

This project is funded by the UN Interagency Standing Committee Global Nutrition Cluster

To download an invitation to collaborate please click here

Problem Statement

Provision of guidance on the management of malnutrition in infants under six months of age is severely hampered by a poor evidence base upon which to base materials. Consequently, there are difficulties supporting these infants in practice. These have been highlighted over the past 6 years as published concerns, debate, and documented field experiences. A collaboration of agencies (IFE Core Group) has been formed to work on policy guidance and capacity building on Infant and Young Child Feeding in Emergencies (IFE). This has contributed to a WHO technical review of the management of severe malnutrition and, more recently, to an international meeting on improving the management of severe malnutrition. Efforts have been made to ‘stop-gap’ the lack of guidance to support field practioners.

However, the continued lack of a solid evidence base has contributed to the fact that both international facility and community-based strategies to manage malnutrition do not specifically address the needs of this age group. This problem, highlighted most recently at an IFE international strategy meeting, urgently needs to be addressed.

Project Aim

To investigate the management of moderately and severely malnourished infants under six months in emergency programmes in order to establish good practice guidelines.

Objectives

(1) To establish what is currently is advised or recommended in the form of guidelines, policies and strategies by different organisations:

- what admission and discharge
criteria are recommended?

- what therapeutic management
is recommended?

- how do care practices and
psychosocial support feature in management?

- how does breastfeeding
support feature?

(2) To determine what is carried out in practice:

- are programme policies reflected by programme practice?

- what % of current feeding programme admissions are infants <6months age - what are numbers admitted vs numbers expected from population surveys? (is coverage and programme impact measured – if so, how?)

- what are key contextual factors affecting admission numbers and management strategies - how do key variables and outcomes interrelate (based on an analysis of retrospective (3 year) data collected in routine programming)

- what are key challenges and constraints?

Settings

The MAMI review will include the following programmes:
• Facility and community based therapeutic and/or supplementary feeding programmes in complex emergencies; natural disasters; and stable situations
• Treatment and/or prevention programmes targeting children < 5 years and/or pregnant/lactating women.

Key Project Outputs

 1) MAMI “Best Practice’ interim guidelines These will differentiate areas where consensus is currently possible and those where more evidence is needed to choose between a range of therapeutic options. 2) Understanding of gap areas and suggestions for research that is needed to strengthen practice 3) Understanding of how (and if) current agency recommendations and practice differ from WHO guidance on management of severe malnutrition. Evidence from the MAMI project will engage with and feed into the current review process of the guidelines on the WHO management of severe malnutrition led by the International Malnutrition Taskforce. Findings will be shared through the ENN regular publication, Field Exchange and through peer reviewed journal articles. Updates and a presentation of the findings will be shared at the Global Nutrition Cluster meetings and at international fora, such as the UN SCN meeting in 2009.

We would value your contribution and inputs:

Please contact Marko Kerac if you like to know more about the project or may be able to help contribute to our understanding of current field practice in this area.

Email: marko.kerac@gmail.com

Project websites:

http://www.ucl.ac.uk/cihd/research/nutrition/mami
http://www.ennonline.net/ife/