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Guidance for CMAM expanded admissions criteria

This question was posted the Management of wasting/acute malnutrition forum area and has 5 replies.

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Forum Moderator, ENN

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30 Sep 2014, 13:46

From Jeanette Bailey: Dear colleagues, In recent months a number of agencies have come together to consider simplified and temporary measures to expand their reach to malnourished children under exceptional circumstances during emergencies. We agreed to draft a guidance note that summarizes agency experiences using expanded admissions criteria in the Outpatient Therapeutic Feeding Programs (OTPs) and extending treatment to MAM when Targeted Supplementary Feeding Programs (TSFPs) were not available. The draft guidance note includes multiple scenarios, including when TSFPs are available but OTPs are not, as well as providing a temporary option for treating acute malnutrition when there is neither an OTP or SFP yet established (as a temporary solution while CMAM programs are being set-up). These options are all intended to be temporary and for use in exceptional circumstances only. The draft guidance note gives a brief overview of the operational evidence backing the recommendations, and considers examples from Niger, Pakistan, and South Sudan. Please note this guidance note is a draft only, and we are still in the process of updating it with more agency experiences. We are also developing a decision tree in order to more clearly define the parameters for its use. We are posting on en-net in order to seek feedback and engage a larger group of experts and field practitioners in the consultation process. This draft guidance note was discussed at the GNC meeting in Rome Sept 16-18, and will be presented for feedback at the ENN Oxford technical meeting on Oct 9. We welcome your questions, ideas, and comments and will revise the guidance note based on your feedback. Many thanks, Jeanette

Jeanette Bailey

Nutrition Technical Advisor, IRC

Normal user

6 Oct 2014, 20:19

Dear colleagues, As a complement to our presentation at the ENN technical meeting in Oxford this week, we would appreciate your feedback on the draft inter-agency guidance note on using expanded admissions criteria during emergencies. Specifically, we are seeking feedback on the following questions: What criteria would you propose to clarify when or when not to use expanded admissions criteria to integrate SAM/MAM treatment during an emergency? Can you share your experiences when either RUTF or RUSF was not available, and the solutions you explored to ensure treatment programs were not disrupted? Thanks, Jeanette


Normal user

13 Jan 2015, 21:46

Thank you for sharing the guidance note and I have some questions 1. why do MSF use weight-for-height ratio <80% but MUAC<110mm 2. what is the initial ground to use dosage Dosage: <115mm- 2 RUTF/day, between 115mm - <125mm- 1 RUTF or RUSF/day 3. what is the criteria to from expanded if the one or two of the unavailable components already started.TO make clear if a SAM child was on RUSF and the OTP program now available how to switch to RUTF, why not end with RUSF

Stien Gijsel

Knowledge management and digital innovation, WFP

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19 Jan 2015, 15:08

Thank you for your response. I am currently replacing Jeanette. I will try to answer your questions in the same structure: 1. The study in Niger was conducted in 2006, when weight-for-height was still used. The admission criteria were meant to cover severe and moderate acute malnutrition simultaneously and only distinct between with and without complications. Although MUAC cut-offs even then were <125 mm for MAM, the MSF team on the ground decided to use 110 mm instead. I would need to contact the team responsible for the study. The study is included as it does provide OTP treatment with expanded criteria, but as you can see later on, this guidance note does request to use more updated admission criteria based on MUAC. 2. The difference is made between severe and moderate acute malnutrition where in SAM, the treatment is meant to cover all nutritional needs and thus amount of RUTF or RUSF is higher. For MAM cases, the treatment is meant to be supplemental and thus lower amount is provided. This is in line with international recommendation although this guideline is also a temporally solution in case of emergency, and thus normal national and international protocols/guidelines should be followed the moment all products are available. 3. This is maybe not clearly defined in the guidance note, but it does mention that the moment the needed treatment programs with nutrition products are available, transition to treatment based on local national and international protocols/guidelines should be done. How this transition should be organized depends on the situation at hand, and thus might need to be identified on an individual basis till this is defined. Does this respond your questions? Are you considering implementing the guideline? If you do, it would be interesting if you could share your results as this guideline is still very much under development and field experience might strengthen it. Regards, Stien


Normal user

19 Jan 2015, 15:51

Thank You Stien! Shishay

Anonymous 635


Normal user

13 Dec 2018, 07:24

Dear All
Any development on final decision/guidelines/recommendation

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