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Adaptation of MAMI criteria

This question was posted the Management of small and nutritionally at risk infants under six months and their mothers (MAMI) forum area and has 4 replies.

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Melanie Spears

Community health coordinator at G2 hospital, Chad

Normal user

3 Jan 2023, 15:31

Hello, I am looking into whether the MAMI pathway could be adapted and implemented in the hospital I work at in Chad. In our context the vast majority of mothers give water alongside breastmilk to their babies under 6 m. Although we would ideally follow up all these babies I don't think we would have the capacity. All the mothers who attend the vaccination clinic are given advice about exclusive breastfeeding and the dangers of giving water and other liquids. We follow up mothers who have concerns about their breastmilk production and stopping giving water and use the national SAM protocol for infants under 6 m. 

If anyone has any experience in adapting the criteria for a similar context I would be very interested. 

ACHE Abdoulaye

Nutritionniste et responsable des projets nutritio

Normal user

3 Jan 2023, 18:31

The management of infants under 6 months is done in a stabilisation centre/inpatient care or NICU in a hospital setting. The clinical examination of the infant and the mother is undertaken, then treatment provided through supplementary suckling technique using F100 diluted according to the specific protocol.

Preparation 670ml of drinking water and 1 sachet of F100.

135ml of diluted F100 for 100kcal

The goal is stimulated breast milk production.

For children under 6 months with edema we must start with F75 then we go to diluted F100

Melanie Spears

Community health coordinator at G2 hospital, Chad

Normal user

4 Jan 2023, 15:34

Hello Ache, thank you for answering. We currently use the National Protocol for the Management of Acute Malnutrition. My question is rather about the MAMI pathway (see https://www.ennonline.net/mamicarepathway-translated-versions ) and the adaptation of the admission criteria to our context.

Marie McGrath

ENN

Frequent user

4 Jan 2023, 16:33

Dear Melanie,

The context you describe and the challenge of the common use of water in addition to breastmilk is one that is shared by many. There may be many reasons why this prevails despite advice to exclusively breastfeed. For example, qualitative research in Ethiopia (ahead of an RCT of the MAMI Care Pathway) found that use of water was common and linked to social and cultural norms, with famly members recommending this to mothers and it being considered neglectful not to provide it. Alive and Thrive have developed some wonderful resources as part of their Stronger with Breastmilk Only Campaign in West and Central Africa that you may find helpful to apply. (available in French and English).  https://www.breastmilkonly.com/fr  As part of this it may be helpful to investigate more closely with the mothers what are the reasons behind using water and who advises them to do so.  It may well be that you then need to target those who influence mothers and may be giving conflicting advice which puts her in a diffiuclt position.

In terms of 'adaptation' of the MAMI Care Pathway, I'm not quite sure what you mean so apologies if I have misinterpreted. 

For those infants that you identify in hospital, if they are newborns, it would be wise to pay particular attention to those born low birth weight as they are at higher risk.  So making sure they have breastfeeding support pre-discharge and then doing what you can to secure follow up in the community, such as in growth monitoring and encouraging them to present to a health clinic if there are health/growth problems or concerns.

For those infants coming for vaccination, this is a great opportunity to assess infants attending and identify those at risk. So assessing weight (to identify if underweight), asking for any breastfeeding problems/concerns (like you are wisely doing).   As well as applying the national SAM treatment guidelines, you can also consider to apply IMCI guidelines/protocols that exist (and upon which the MAMI Care Pathway is based and supports). IMCI uses weight for age as a criterion, as well as health indicators, to triage for problems and [provides community based guidance so may be useful to apply in your context too, helping to identify relevant existing services to link babies you identify in hospital or at vaccination.

I hope that helps but please continue to ask further questions/add clarifications as you wish, as I know there are many out there who both share your challenges and can also contribute to this discussion.

Best regards, Marie

Marie McGrath

ENN

Frequent user

4 Jan 2023, 16:33

Dear Melanie,

The context you describe and the challenge of the common use of water in addition to breastmilk is one that is shared by many. There may be many reasons why this prevails despite advice to exclusively breastfeed. For example, qualitative research in Ethiopia (ahead of an RCT of the MAMI Care Pathway) found that use of water was common and linked to social and cultural norms, with famly members recommending this to mothers and it being considered neglectful not to provide it. Alive and Thrive have developed some wonderful resources as part of their Stronger with Breastmilk Only Campaign in West and Central Africa that you may find helpful to apply. (available in French and English).  https://www.breastmilkonly.com/fr  As part of this it may be helpful to investigate more closely with the mothers what are the reasons behind using water and who advises them to do so.  It may well be that you then need to target those who influence mothers and may be giving conflicting advice which puts her in a diffiuclt position.

In terms of 'adaptation' of the MAMI Care Pathway, I'm not quite sure what you mean so apologies if I have misinterpreted. 

For those infants that you identify in hospital, if they are newborns, it would be wise to pay particular attention to those born low birth weight as they are at higher risk.  So making sure they have breastfeeding support pre-discharge and then doing what you can to secure follow up in the community, such as in growth monitoring and encouraging them to present to a health clinic if there are health/growth problems or concerns.

For those infants coming for vaccination, this is a great opportunity to assess infants attending and identify those at risk. So assessing weight (to identify if underweight), asking for any breastfeeding problems/concerns (like you are wisely doing).   As well as applying the national SAM treatment guidelines, you can also consider to apply IMCI guidelines/protocols that exist (and upon which the MAMI Care Pathway is based and supports). IMCI uses weight for age as a criterion, as well as health indicators, to triage for problems and [provides community based guidance so may be useful to apply in your context too, helping to identify relevant existing services to link babies you identify in hospital or at vaccination.

I hope that helps but please continue to ask further questions/add clarifications as you wish, as I know there are many out there who both share your challenges and can also contribute to this discussion.

Best regards, Marie

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