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Admission and discharge criteria for children with MAM

This question was posted the Management of wasting/acute malnutrition forum area and has 4 replies.

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Sophiya Uprety

Normal user

14 May 2013, 11:14

For a national guideline on managment of MAM, we are looking for guidance on admission and discharge criteria for children aged 6-59 months. Please confirm that the following are the most updated global recommendations: Admission: If MUAC >= 115 mm and <125 mm AND/OR WFH < -2 z-score & >= - 3 z-score of the WHO Growth Standards Discharge:MUAC >=125 mm for two consecutive visits AND >=-2 z-score WHO Growth Standards for two consecutive visits Also, requesting if anyone has programmatic experiences to share on discharging children using both criteria.

Mark Myatt

Frequent user

15 May 2013, 10:21

As part of the scaling up of the CMAM Surge approach in Mali, with the financial support of ECHO, SCI is recruiting an expert in CMAM Surge based in Bamako for a period of 1 year.
1. Capacity building of actors
- Develop curriculum and materials for trainer training of CMAM Surge Focal Points
- Ensure the preparation and logistical organization of the training of trainers
- Facilitate training of trainers including pre / post tests
- Write the training report
2. Strategic Planning and Technical Leadership for Upgrading the CMAM Surge Approach
- Develop the scaling plan jointly with partners including monitoring and success indicators and monitor them
- Provide high quality technical assistance to partners through remote and on-site monitoring
- Support the partners in the facilitation of the workshops of the different sessions (Risk analysis, capacities, establishment of thresholds, definition of Surge actions, finalization, budgeting and financing of actions, and formalization of commitments)
2. Evaluation & Capitalization
- Support partners in the development of implementation reports of the CMAM Surge approach
- Promote good practices and shared learning with other implementing actors during the exercise
- Produce a capitalization report on scaling the CMAM Surge approach

3. Representation and Coordination
- Work closely with the State including the Ministry of Health and its various members for effective implementation of interventions;
- In conjunction with the Advocacy team, support advocacy for the CMAM Surge Scaling Plan in coordination meetings and technical working groups, as well as other appropriate types of fora at the circle, regional, and other levels. national and international;
- Participate in the meetings of the working groups and steering committees on the CMAM Surge approach at both national and regional level and ensure a coordinated and harmonized approach to the process;
- Maintain regular, close and constructive contacts with Save the Children's technical assistants and national partners to ensure compliance of the Program's efforts with national and international standards;
- Work closely with Country Office Health and Nutrition Advisors on all technical issues related to the Program;
4. Supervision and development of the staff
- Supervise the national manager of the CMAM Surge scaling program
- Develop the technical and managerial capacities of the national manager for a transfer of responsibilities

- Have a master's degree in Public Health (or equivalent)
- At least 5 years of professional experience in strengthening health systems in general and the CMAM Surge approach in particular
- At least 3 years of professional experience integrating the management of acute malnutrition into health systems
- At least 3 years of professional experience in building the capacity of state and international partners
- Experience in planning and funding emergency response plans for health systems
- Experience in facilitating workshops to produce evidence and lessons learned
- Be familiar with Mali's national policies and strategies on health, nutrition and gender
- Have a perfect command of French and an effective operational competence of English;
- Ability to interact positively with a multitude of partners from different horizons
- Proactive and decisive behavior.
- Have experience in creating training materials, facilitation, adult training and communication;
- Experience in writing reports and other technical notes for different types of audiences.

Applications must be sent no later than 28/04/2018 at 5 pm sharp only via the following email address:


Forum Moderator, ENN

Forum moderator

15 May 2013, 12:28

Hi Sophiya, A recent consultation hosted by SCUK and supported by the ENN, UNHCR and ACF agreed that low MUAC and WHZ often identify different children and that there may be risks associated with both indicators. This consultation focused on severe acute malnutrition, but agency experiences were also shared on MAM. The report can be found here: There are some operational experiences in annex and references that might be useful for you. Best wishes Tamsin


Dirrector, Health & Nutrition/

Normal user

15 May 2013, 13:59

While it may make sense to drop WHZ for MAM admissions, we are admitting SAM U5 with any one criterion into a CMAM programme with all the basic four components and discharging when both criteria and a 15% weight gain are attained for two consecutive weeks. While the cases by WHZ may be at less risk compared to SAM by MUAC, they are still at high risk for developing comorbity and less than satisfactory physical and mental development. Also, children having physical appearance suggesting severe case even with a normal MUAC, we admit. In SE Asia with over 600 enrolled last year in 2012. Ehsan


Registered Nutritionist & Dietician

Normal user

16 May 2013, 06:41

It is important to note that you are within the global guidelines for your admission and discharge criteria. Please keep in mind that Acute malnutrition can be triggered by something as small as a diarrheal or a fever episode. It is good to remain focused on the objectives of the nutrition intervention in MAM. Weight is a very sensitive indicator of malnutrition and is important in surveillance hence tracking every slight change in anthropometry. MUAC on the other hand is a significant predictor of mortality but it takes a long time to achieve significant change. MAM admissions can be discharged by visit 2 which is averagely on the 4th week. This may be achieved by assessing WHZ to avoid overstay or oversubscription of clients. MUAC is better used when tracking SAM.

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