Training Guide for Community-Based Management of Acute Malnutrition (CMAM)

English version 1.0 released November 2008
French version 1.1 released November 2010

EXPLANATION OF THE DIFFERENCES BETWEEN THE ENGLISH AND FRENCH VERSIONS OF THE GUIDE

FANTA worked with partners to develop a generic Training Guide for Community-Based Management of Acute Malnutrition (CMAM). The first version of the training guide in English was released in November 2008. The guide used admission and discharge criteria that were consistent with international guidance for management and treatment of severe acute malnutrition (SAM) at the time of publication. Since then, the World Health Organisation (WHO) has updated some of its recommendations on the management of SAM in children 6-59 months. As of 2010, WHO recommends:

• Besides mid-upper arm circumference (MUAC) and presence of oedema, using weight-for-height (WFH) z-score based on the WHO child growth standards instead of WFH as a percentage of the median based on the National Centre for Health Statistics (NCHS) growth reference for identifying acute malnutrition and for admission/discharge criteria

• Raising MUAC admission cutoff to 115 mm from 110 mm for severe acute malnutrition

• Using new criteria for discharge based on: weight gain of 15 percent, oedema free for 2 consecutive visits, and child is clinically well and alert. These discharge criteria are used for all admissions, regardless of the admission criteria used.

FANTA had already been working on a translation of the guide, and has incorporated the WHO recommendations into the French version. Due to high demand, we are releasing the French version of the training guide while still working on updating the original English version. Due to smaller file sizes, we are using Microsoft Word 2007 files for downloads from the website. If you would like the files in Microsoft Word 1997-2003, please send your email request to fantamail@fhi360.org [or download a compatibility pack from Microsoft here].

In the interim and while using the English version, we recommend that the content should be adapted to take into account national guidelines, local considerations, and the WHO recommendations. A fact sheet explaining the new recommendations is available at
http://www.unscn.org/Publications/html/task_force/who_growth_standards_final.doc.

OVERVIEW OF THE TRAINING GUIDES

A significant gap remains between need and capacity for management of severe acute malnutrition (SAM) in children. This is despite clear advances in the development and implementation of international and national protocols for the management of SAM, as well as guidelines and training for inpatient care of severely acutely malnourished children. The Training Guide for Community-Based Management of Acute Malnutrition (CMAM) aims to address this gap by increasing knowledge of and building practical skills to implement CMAM in both emergency and non-emergency contexts.

CMAM offers great potential for treating the majority of children with SAM with good appetite and no medical complications, at home through decentralized outpatient care, while also providing for inpatient care for those who need it: children with SAM with poor appetite and medical complications, and infants with SAM less than 6 months old. CMAM also includes community outreach for early case detection and timely referral for treatment and may include linkages to programs and services to manage moderate acute malnutrition and prevent acute malnutrition from impairing healthy growth or becoming life threatening.

The training guide is designed for health care managers and health care providers who manage, supervise and implement CMAM. This includes health care providers who are involved in health outreach activities, as well as MOH officials at the national, regional and district levels, health and nutrition program managers of NGOs and United Nations technical staff.

The training guide was produced in collaboration with Concern Worldwide, Valid International and UNICEF, with technical input and review from USAID, WHO and numerous non-governmental organizations working to lessen the impact of SAM on children. Support for the development of the training guide was provided by USAID's Bureau for Democracy, Conflict and Humanitarian Assistance's Office of Foreign Disaster Assistance and Bureau for Global Health's Office of Health, Infectious Diseases, and Nutrition.

Copies of the CD-rom are available by emailing your request to fantamail@fhi360.org.

English
Version