National Nutrition Cluster
CMAM Technical Working Group
Meeting No. 3
16 December 2013 ● 9:00 am – 12:00 noon ● NNC Conference Room
Attendance
1. Dr. Martin Parreno, ACF
2. Roger Mathisen, Global Nutrition Cluster
3. Director Asuncion Anden, NCHFD
4. Josephine Guiao, NCHFD
5. Dr. Brenda Fuentes, NCHFD
6. Dianne Kristine Cornejo, NNC
7. Margarita Enriquez, NNC
8. Dr. Nureyan Zunong, Plan International
9. Evelyn Carpio, UNICEF
10. Dr. Amado Parawan, Save the Children
Highlights of Discussion
1. Dr. Parreno presented the mapped resources available from partners. A query was raised on micronutrient powders (MNPs). Initially, the approach base from WFP’s plan was for children aged 6-23 months old, they would receive plumpy doz; for those 24-59 months old, they would have MNPs. Ms. Lindsey Horton of WFP, mentioned that due to challenges in the availability of MNPs, high energy biscuits will be utilized instead. Mr. Mathisen further mentioned that distributing MNPs is not relevant as of now because when blanket supplementary feeding program (BSFP) will be conducted for 2 months, the products (plumpy doz, plumpy sup and high energy biscuits) that will be given are already fortified. After 2 months of BSFP, those children aged 6-59 months old will receive MNPs.
2. There are enough stock of MUAC tapes. UNICEF has already distributed MUAC tapes in the typhoon affected areas.
3. Dr. Parreno informed the group that the approach in the Strategic Response Plan is to do blanket supplementary feeding for the first 2 months to prevent malnutrition and promote good nutrition. But in some areas where CMAM is already established, treatment for SAM and MAM can be started.
4. According to Mr. Mathisen, in the Philippines, Cambodia, and Vietman, only 1/3 of the SAM and MAM cases were identified using the MUAC. He suggested that if a child falls under yellow (moderate) on MUAC, and that MUAC usually identifies girls, weight-for-height needs to be done in order to identify additional SAM cases and for validation purposes. On the other hand, ACF’s practice is to take WFH/L for all children with MUAC between 125 to <134 mm to ensure that SAM cases are all captured either by MUAC or WFH/L.
5. Dr. Parawan shared that during the Bangkok Conference on Scaling-Up CMAM in Southeast Asia, there have been discussions already to have different cut-off points for African and Asian children as well as to move the cut-off point to 13 cm instead of 12.5 cm. He also shared that there are two types of coverage, geographical and treatment. Geographical coverage aims to measure availability of services for the treatment of SAM or used as “process indicator”, while treatment coverage measures the accessibility and uptake of SAM services or the “impact indicator”.
6. MUAC tape with three colors should only be used for uniformity.
7. Dr. Parreno presented the treatment algorithm which will be provided to all health workers. There is also a plan to distribute the algorithm as an IEC material.
8. Mr. Mathisen suggested to have standby agreements if PCAs take 5 to 6 weeks and since emergencies in the Philippines happen quite often.
9. In reply to Ms. Guiao’s query on who will accomplish and consolidate the CMAM monthly reporting form at the hospital, Dr. Parreno said that at the municipal level, it is the municipal action officer, and for the hospital a nurse or midwife can be in-charge; however, in the absence of a nurse or midwife, a nutritionist-dietitian can also be tapped. The quality of the report will be checked by the Department Chair of the Pediatrics. For Save the Children, Dr. Parawan shared that they have community mobilizers who submit reports to the Save the Children staff in consultation with the midwife of the Rural Health Unit, then, reports will be submitted to the project coordinator per municipality.
10. The reporting form used in Bohol was presented to the group which is being used now in Region 8. Mr. Mathisen suggested including gender in the said form. This will be merged with the OPT plus form of the NNC.
11. The monthly statistics form is used both in the outpatient and inpatient treatment program.
12. Region 6 is conducting screening of PLWs.
13. Ms. Guiao suggested to include the nutritionist-dietitian in the protocol especially the chief dietitian who will be responsible in accomplishing the reporting form.
14. Help Age International shared with Mr. Mathisen the guidelines on treatment of severe malnutrition in the elderly. Furthermore, Mr. Mathisen said that the immediate need for nutrition for the elderly is to understand it better by conducting capacity development training.
15. Ms. Guiao gave a feedback on the CMAM TWG meeting held on 13 December 2013. The meeting was presided by Director Anden of NCFHD, and attended by IMC, ACF, WFP, and HEMS.
a) To include nationwide CMAM training in the Working Financial Plan to be submitted on coming 14 January 2014
b) To collaborate with UNICEF for funding to conduct CMAM training in Regions 6, 7, and 8
c) To collaborate with ACF and Save the Children for technical expertise
d) To involve PPS in CMAM as well as the academe
e) Plan a training design and modify the module to fit DOH hospital personnel
16. When supplementary feeding program is available in the area, the child can be discharged at z-score -2; otherwise, the child can be discharged at z-score -1.5.
17. When a child is admitted using MUAC, the child should also be discharged using MUAC. The same is true when the child was admitted using WFH/L.
Action Lines:
1. ACF to share to the CMAM TWG copy of the treatment algorithm for comments and review
2. ACF to share three reporting forms (forms used at the barangay, regional/national level, and monthly statistics form) for comments and review
3. UNICEF to follow-up status of PCAs and to provide list of commodities/supplies available
4. Save the Children to submit list of commodities/supplies available for supply mapping
5. DOH to discuss with PhilHealth to come up with clinical practice guidelines for children with SAM
6. Mr. Mathisen to share the guidelines on treatment of severe malnutrition in the elderly
Prepared by:
Margarita D.C. Enriquez
Nutrition Officer II, NNC
Noted by:
Dr. Martin Parreno
Chair, CMAM Working Group
National Nutrition Cluster
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