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Treatment of MAM for pregant and lactating women

This question was posted the Management of wasting/acute malnutrition forum area and has 6 replies.

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Anonymous 118

Nutrition Advisor

Normal user

2 Jun 2011, 14:06

Is there an internationally accepted standard protocol for treating pregnant and lactating women with MAM? Which is more widely accepted for women who do not respond to treatment for MAM: should the program be time-bound – say for 4 months – or is the woman best kept in the program until she her MUAC is <210 or the baby is 6 months old regardless of whether her condition improves?

Emily Hockenhull


Normal user

12 Apr 2021, 12:21

Hoping to reopen this topic, does a standardised protocol exist? I've seen it nestled within CMAM guidelines, however is there an internationally recognised protocol that can be used and adapted according to context? 

Philip James

Senior Technical Associate, ENN

Frequent user

19 Apr 2021, 18:28

Hi Emily, I don't think there is a standard protocol for treating PLW with MAM. Different agencies still use different MUAC cut-offs to define SAM and MAM with PLW, as well as different discharge criteria. It would be great to hear from practitioners on their experiences of programme implementation for PLW. 

At ENN we're currently updating our maternal nutrition brief, and so if we find up-to-date resources on this we'll update you! It does seem to be a big gap...

Doris Mwendwa


Normal user

20 Apr 2021, 08:05

Based on my past field experience in different contexts this is clearly defined in the country CMAM guidelines. Some countries include MUAC less than 21cm while others include MUAC less than 23 cm.

Length of stay: Lactating women are discharged when baby is 6 months despite the MUAC measurements while a pregant mother is discharged upon reaching MUAC above 21cm.

Mogadam Nazal

Nutrition officer

Normal user

20 Apr 2021, 09:15

Hi dear, hope you are doing well. According to Sudan MAM guideline 2020 for PLWs the admission criteria is as follows:

-the pregnant woman should be in second/third trimester and her MUAC is less than 21 cm

-lactating woman also her MUAC is less than 21cm and the child is less than six months old (exclusively breastfed).

and for the two (PLWs) length of the stay (duration in the program) is 3 months 

for the discharge criteria when the PLWs MUAC reach <=23 cm (greater than or equal) for two consuctive visit (cured).

for the non-responders PLWs stayed  the whole three months in the program and not reach the discharge criteria.

for the defaulters PLWs absent for three consecutive visits, and they are discharged as death while she dead during the program (during the three months)

wish you all the best

Mija Ververs


Normal user

20 Apr 2021, 14:33

Dear colleagues

With great interest I read your questions and comments. The guidance on MAM and SAM for PLW is not very well established, sometimes contradictory or without solid rationale. My comment below is not directly related to the treatment programmes but more enrollment criteria.  A few years ago we looked into this and published something more specific on the science behind thresholds for MUAC and Pregnant women (only...; as the information regarding Lactating women was virtually non-existent). What we found at the time is that there was no justification behind putting PW in specific SAM or MAM categories (see here for the link to the article we published at the time Which anthropometric indicators identify a pregnant woman as acutely malnourished and predict adverse birth outcomes in the humanitarian context?

We are currently revising this subject and also hope to send out an informal survey to practioners (you!) and also use this forum. In this survey we hope to learn more from you on the treatment programmes, compare and look at rationales. So look out for this and we hope you can participate. I estimate we will post it in the next 2-4 weeks.

Regards, Mija

Pat Mc Mahon

Mothers First

Normal user

20 Apr 2021, 14:56

Thanks for all the interesting comments. It might great if people could share where these programs are actually running. What interventions are given, what outcome indicators do we look at.

The Investment Framework for Nutrition by the World Bank and the updated  Lancet Maternal and Child Nutrition Series shows us that the scale-up of Essential Nutrition Action that focuses on the first 1000 days remains statically low.  

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