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 firstname.lastname@example.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
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