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CMAM

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 4 replies. You can also reply via email – be sure to leave the subject unchanged.

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Shishay

Normal user

13 Oct 2015, 14:31

Dear All,

What is the definition of CMAM ? is there any update on the components of the CMAM ? recently there were discussions to include/or not the SC in the south Sudan CMAM guideline development , in addition professionals were not having similar understanding either the PLW MAM management is to be part??

Regards

Anonymous 2550

Nutrition specialist for World vision Ethiopia

Normal user

13 Oct 2015, 21:11

Dear Anony 2785,
Thank you for sharing your concern;
CMAM is a community based approach to manage both SAM and MAM cases through community and facility based services; it has 4 major components: community outreach, Outpatient Therapeutic Program (OTP), In-patient Therapeutic unit (TFU) and Targeted Supplementary Feeding Program (TSFP).
Dear Anonym 2785, its up to the professionals whether to develop separate guidelines for each components or not but if I share you the experience of Ethiopia, development of guideline primarily accounts service delivery points and understanding level of service providers. For example, for OTP, we have a mini reference book (quick reference) for Health extension workers, which was prepared in a simple and understandable way; likewise, we have a comprehensive guideline which encompasses all the components, and usually referred by Nutrition focal Nurses at the HC and Hospital level ;
Personally, I prefer including all components in one guideline as they all are interlinked, and helps to easily access, especially while managing transferred cases. This also works for MAM cases (under five +PLW) in TSFP.
Finally, I kindly suggest you to refer the Ethiopian SAM management protocol 2007 and 2013 edition for further information.

Thanks
Feleke M

Mark Myatt

Consultant Epideomiologist

Frequent user

14 Oct 2015, 08:54

I feel we have to define CMAM for what it is rather than for what we would like it to be.

I tend to use the term "CMAM" to mean OTP with (if possible) inpatient stabilisation. This is because of the CTC heritage. A name change (i.e. "CTC" becomes "CMAM") was required because a number of NGOs and experts were very strongly and very publicly opposed to the CTC model of care for SAM cases. The name was changed to allow these people to adopt CTC and save face.

Some people like to include a lot more that OTP/SC in CMAM ... TSFP, FBPM, &c. The problem with this is that SAM and MAM programs are rarely integrated. They tend to be managed by different UNOs, NGOs, and government departments and to be delivered in different locations. Interface issues abound. It is not uncommon (e.g.) for previously SAM kids to get lost in the system when transferred to SFP or for MAM kids in SFP to become SAM but not be referred to OTP. In many settings the TSFP, FBPM, and other components are absent or patchily implemented. In Sudan (e.g.) OTP/SC is a national program but TSFP and FPBM are implemented in only a handful of states. In this setting CMAM really means OTP/SC.

I think that (e.g.) TSFP can only be considered to be part of a CMAM program if they are tightly integrated with OTP services.

I am in favour of the wider "integrated program" or "one program" CMAM treating both MAM and SAM and closely linked with program such as GMP for case-finding but I think this is seldom achieved.

Shishay

Normal user

15 Oct 2015, 06:37

Thank you Felek and Mark,

Yes I do agree with the suggestion to have comprehensive and integrated CMAM guideline which includes OTP/SC and TSFP while the BSFP can be considered as optional similar with other preventive aspects. I am aware the Ethiopia National CMAM guideline is comprehensive as an umbrella while coming operational wise it is contextualized like having the MAM guideline , SAM protocol and the HEWs quick reference

Particularly with South Sudan , where things are started from the scratch all national guidelines and protocols are still not yet or under draft versions , the CMAM guideline should be comprehensive, where there will not be missed opportunities, components will run hand in hand and easy referral linkages . Partners and professionals should understand the context , instead of the theory.

Thank you again.

Paul

Technical expert

15 Oct 2015, 08:09

The Government of South Sudan has IMSAM guidelines in place which can be downloaded here. These are integrated guidelines which include all of the components of CMAM from 2009
[https://www.humanitarianresponse.info/en/operations/south-sudan/document/goss-moh-imsam-guidelinesnov15-word-2009-version]

The Nutrition cluster has a resource site for nutrition related documents;
[https://sites.google.com/site/nutritionclustersouthsudan/documents-1/guidelines]

You may also be interested in this document discussing the integration of CMAM programming in South Sudan,
[http://www.malariaconsortium.org/media-downloads/248/]

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