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Continum of care for SAM and MAM

This question was posted the Management of wasting/acute malnutrition forum area and has 3 replies.

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Normal user

14 Nov 2022, 16:27

In settings where both UNICEF and WFP are active, is there

A global guidance/recommendation that says that UNICEF will treat the SAM child until the MAM stage as part of CMAM?

My understanding is that treatment is until full recovery…thus >12.5cm MUAC

When the child becomes MAM, he/she should be discharged from the Outpatient treatment and referred to a WFP-assisted MAM treatment programme?

My understanding is that MAM children are screened and identified for treatment as a preventive measure before they become SAM

Also, in some settings, they are referred to food-based interventions as a nutrition safety net

Mhiret Teshome

Nutrition Expert

Normal user

15 Nov 2022, 12:46

I'm not also clear on their exclusive role. However, following the launch of GAP (Global Action Plan) on Child Wasting in 2020, both organizations developed partnership framework in 2021 to work more closely and in harmoney in the fight against global wasting. As it is indicated in the GAP framework, UNICEF is the lead agency in the management of child wasting (both MAM  and SAM) while WFP has a supporting role. You may refer the following for the detail on the role of each agency.

Coming to the treatment and recovery:

The use of RUTF until full recovery  (MUAC > 12.5 cm) is common at least in my context (Ethiopia). This is also stated in the national guideline. This is because the supplies availabilty for the MAM treatment (RUSF/CS) is not reliabe all the time. Only about 25% of district have access to these supplies with interruptions. Given the HHs food security is low, child care  and feeding practice is poor; children discharged without full recovery will have high risk of replapse.

The purpose of RUSF/CS is both for preventive and treatement puprose. While preventing deterioration to SAM it also proved that can treat those children with acute malnutrition. There is a filed exchange summary of findings on this regar on ENN this web site. Link:,probable%20effect%20of%20nutrition%20education. 

Nyauma Nyasani

Normal user

15 Nov 2022, 12:49

As you have clearly stated, UNICEF and WFP are active in the context in question. This sets good ground to respond to your question. Both UNICEF and WFP are working in partnership toward addressing wasting in children (6-59 months). Wasting here, assessed by MUAC, refers to severe acute malnutrition (<11.5cm) and moderate acute malnutrition (MUAC between 11.5cm and 12.5cm). Through a global action plan (GAP), both agencies (UNICEF and WFP) are supporting governments in scaling up early detection and treatment of children with wasting in health facilities and communities and this cultivates a conducive environment for insitutionalised continuum of care for children presenting with wasting. That being said, children admitted with MUAC <11.5 cm are retained in the treatement programme (using RUTF) until full recovery (MUAC >12.5cm). A child screened and found with moderate wasting is admitted to targeted supplementary feeding programme (often using RUSF) until discharged at MUAC >12.5cm.

Le Minh Tram

Nutrition Specialist

Normal user

30 Nov 2022, 15:21

Dear Sanele,

I understand your initial question is about the discharge criteria for a SAM child admitted in outpatient centers. The latest WHO updates (2013) clearly states the below:

Children with severe acute malnutrition should only be discharged from treatment when their:

  • weight-for-height/length is ≥–2 Z-score and they have had no oedema for at least 2 weeks,
  • or — mid-upper-arm circumference is ≥125 mm and they have had no oedema for at least 2 weeks.

(Page 20 of the WHO updated guidelines on the management of severe acute malnutrition, 2013)

New recommendations should come in 2023, but this specific one should not change.

I hope this helps.

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