Invitation to Collaborate:

MAMI

(Management of Acute Malnutrition in Infants)

A retrospective review

of the current field management of

moderately and severely malnourished infants

under six months of age

Project management:

Emergency Nutrition Network (ENN)

32, Leopold Street, Oxford, OX4 1PX, UK

Implementing partners:

UCL Centre for International Health & Disease,(CIHD)

Institute of Child Health

30 Guilford Street, London, WC1

Action Contre Faim (ACF)

4 RUE Niepce 75662 Paris Cedex 14, France

Interagency Steering Committee (IASC):

Being formed

Research Advisory Committee (RAC):

Being formed

Project funding:

UNICEF led Inter Agency Standing Committee (IASC) Nutrition Cluster

Key contacts:

- Marko Kerac, (Lead Researcher) CIHDEmail:

- Marie McGrath, ENNEmail:

- Andy Seal, CIHD Email:

- Cecile Bizouerne, ACFEmail:

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[i]. Consequently, there are difficulties supporting these infants in practice. Thesehave been highlighted over the past 6 years as published concerns[ii], debate, and documented field experiences[iii]. A collaboration of agencies (IFE Core Group) has beenformed to work on policy guidance and capacity building on Infant and Young Child Feeding in Emergencies (IFE)[iv]. This has contributed to a WHO technical review of the management of severe malnutrition[v] and,more recently, to an international meeting on improving the management of severe malnutrition[vi].Efforts have been made to ‘stop-gap’ the lack of guidance to support field practioners[vii].

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[viii] do not specifically address the needs of this age group. This problem, highlighted most recently at an IFE international strategy meeting[ix], 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 goodpractice 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 doesbreastfeeding support feature?

  1. To determine what is carried out in practice:

- are programme policies reflected by programme practice?

- what % of current feeding programme admissionsare 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?

Setting

The MAMI review willinclude the following programmes:

  • Facility and community based therapeutic and/or supplementary feeding programmes in emergency settings:complex; natural disasters; stable[x]
  • Treatment and/or prevention programmes targeting children < 5 years and/or pregnant/lactating women.

Key Project Outputs:

1) MAMI “BestPractice’[xi]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:

Project websites:

REFERENCES:

1

[i] Severe Malnutrition: Report of a Consultation to Review Current Literature (WHO; 2005)

[ii] Seal A, Taylor, A Gostelow L and McGrath, M (2001). Review of Policies and Guidelines on Infant Feeding in Emergencies. Common Ground and Gaps. Disasters. Vol 25, Issue 2, p136 – June 2001

[iii]Field Exchange 9, Infant feeding in a TFP, p7, Mary Corbett; ENN/GIFA Project, summary of presentation, Field Exchange19, p28; Diet and renal function in malnutrition, Summary of presentation, Field Exchange 19, p24; Debate on the management of severe malnutrition. by Marie McGrath, Jeremy Shoham and Fiona O’Reilly. Field Exchange 20. p16

[iv] Shared experiences in infant and young child feeding in emergencies. Case Studies series on managing malnutrition in infants under six months.

[v]

[vi] Hosted at the Royal Society of Tropical Medicine and Hygiene. See presentations at Infants under six months were not an agenda item which was highlighted in the meeting and discussed as a significant gap area.

[vii] A chapter on managing severe malnutrition in infants under six months was developed in Module 2 as an interim measure by the IFE Core Group, with input from external experts and guided by expert technical opinion and review

[viii]Management of severe malnutrition: a manual for physicians and other senior health workers, WHO (1999) Available in Eng,Fre,Sp,Port from and Community-based Therapeutic Care Field Manual, First Edition, 2006. Valid International and Concern Worldwide. Available from

[ix] Infant and Young Child Feeding in Emergencies. Making it Matter. Proceedings of an International Strategy Meeting, 1-2 November 2006. IFE Core Group. Available at under IFE

[x] The definition of chronic emergencies may need to be refined as the review proceeds. Two suggested definitions are posited: (i) programmes implemented when there is a perceived or expected chronic food deficit/insecurity which leads to elevated malnutrition or is perceived to have an impact on raising malnutrition levels; (ii) chronic food insecurity which at times reaches acute crises (i.e. where levels of malnutrition reach crisis levels).

[xi] O Reilly, 2003.