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International guidelines on Family MUAC and Simplified Approaches

This question was posted the Simplified Approaches for the Management of Acute Malnutrition forum area and has 3 replies.

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Lucia Diaz-Martin

Normal user

23 Aug 2021, 21:49

My understanding is that international guidelines (WHO, Unicef) for screening and treating malnutrition now include family MUAC as of March 2020 (per the Unicef Covid protocols). However, the guidelines do not yet recommend other simplified approaches (like the combined treatment of MAM and SAM with one product - per a March 2019 review). Is this understanding accurate? Any insights as to why, and if the combined treatment is up for approval any time soon given the logic and evidence base? Many thanks!

Mark Manary

Washington University School of Medicine

Technical expert

3 Nov 2021, 03:11

I sit on the Simplified Treatment of SAM committee/ discussion group.  I am not aware of a deadline or time frame to 'come to a decision' about other elements of a simplified protocol.  I do think that each simplification is distinct and separate, and warrants careful consideration.  For example 'using family MUAC' is something that does not replace other activities and really has no downside if treatment is available for mothers who find their children malnourished.  Simple reduction in dosage of RUTF as a SAM child recovers to MUAC > 11.4 cm is associated with less linear growth in a few studies.  This suggests while RUTF may be very well suited for the rapid catchup growth phase, that something is missing with the dose reduction.  Perhaps those closer to the closing the GAP effort might have more insight.

Grace Funnell

Programme Specialist, UNICEF

Technical expert

3 Nov 2021, 14:28

Hi Lucia,

The WHO CMAM Guidelines currently do not reflect any of the modifications included under the simplified approaches. The Covid guidance does allow for these modifications in certain contexts. WHO is currently undergoing a review/update process of the CMAM guidance and will be reviewing the evidence on some of the simplified approaches. We expect the revised guidance out sometime next year. 

Lucia Diaz-Martin

Normal user

3 Nov 2021, 14:55

Many thanks, Mark and Grace! This is helpful. Good to know that decisions for the updates are slated for next year. 

All the best,


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