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Is there an agreed definition of high risk MAM

This question was posted the Management of wasting/acute malnutrition forum area and has 4 replies.

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Anonymous 22505

Public Health Nutritionist

Normal user

10 Jun 2023, 23:33

Given the resource implication for the management of the whole MAM children, it seems there is an emerging approach to prioritize only those high risk MAM to be treated along with SAM cases with single product. If that is the case, is there an agreed definition of what high risk MAM is? Is it just readjusting anthropometry, limiting admission criteria, Or is it targeting those with double (those fulfil both MUAC with WFH; MUAC  with WFA). Of course, geographic vulnerablity and  illness can also be consider?

Coulibaly

CEO Ivoire Global Health

Normal user

12 Jun 2023, 10:16

That's a good point, we have to move torward such definition allowing focused our effort on most at risk MAM.Considering the appeal of WHO Director, let's work hand to hand for saving at least 100 % of them ( 7 countries in the horn of Africa). Why not stay on actual anthropometric measures (Enough strong evidence on the reliability)then add to  the new definition a score (set of criteria) link to: Poverty, area food security etc. Another point is to see how far the definition might be performant to identify the MAM.

Ex MAM: +1 or +2 or +3 etc

Natasha Lelijveld

Normal user

12 Jun 2023, 13:09

Hello. 

Good question. However there is no current definition. There is a study in Sierra Leone which used muac<120, being an orphan, being a twin, and having WAZ<-3 as criteria. Having cough, rash, or fever were also found to indicate high risk.

The WHO are currently working on an analysis of 2ndary data to try come up with some standard criteria. UNICEF have already expanded some SAM programmes to MUAC<120 in order to capture some high risk MAM children. 

So there is much going on in this space, but nothing standard yet. 

Spencer Rivadeneira Danies

Pediatra

Normal user

17 Jul 2023, 04:06

Hola todos.

Tema interesante. El resumen de las directrices 2023, para la prevención y tratamiento de la emacición y el edema nutricional, hace referencia a criterios de priorización para niños con desnutrición aguda moderada con mayor riesgo de no recuperación y de muerte; por lo que deberían ser priorizados. Como criterios de selección, menciona factores individuales y sociales para determinar que niños deben recibir alimentación terapéutica.

Factores individuales: MUAC 11.5 - 11.9 cm, puntuación Z peso/edad -<3DE, edad < 24 meses, circunstancias personales graves (ejemplo, muerte de la madre, entre otros), comoborbilidad grave o crónica (VIH, tuberculosis).

Factores del contexto: altos índices de inseguridad alimentaria, indicadores WASH desfavorables, alta incidencia/prevalencia de emaciación/edema nutricional.

Por cierto, sugiera que, ante la posibilidad de garantizar alimentación familiar adecuada, algunos niños con MAM podrían no necesitar alimentación terapéutica. De ahí la imposrtancia de priorizar según los contextos e individualidades previamente citadas.

Espero que esto alimente la discusión.

Saludos.

English

Hello everyone.

Interesting topic. The summary of the 2023 guidelines, for the prevention and treatment of wasting and nutritional edema, refers to prioritization criteria for children with moderate acute malnutrition at increased risk of non-recovery and death; so they should be prioritized. As selection criteria, it mentions individual and social factors to determine which children should receive therapeutic feeding.

Individual factors: MUAC 11.5 - 11.9 cm, weight/age Z-score -<3DE, age < 24 months, severe personal circumstances (e.g. death of mother, among others), severe or chronic comorbidity (HIV, tuberculosis).

Contextual factors: high rates of food insecurity, unfavorable WASH indicators, high incidence/prevalence of wasting/nutritional edema.

Incidentally, suggest that, given the possibility of ensuring adequate family feeding, some children with MAM may not need therapeutic feeding. Hence the impossibility of prioritizing according to the contexts and individualities previously mentioned.

I hope this feeds the discussion.

Best regards

Stephanie Wrottesley

Emergency Nutrition Network

Forum moderator

17 Jul 2023, 09:15

*Please note that the below is an automatic translation of the above reply by Spencer Rivadeneira Danies (ICBF)

Hi all.


Interesting topic. The summary of the 2023 guidelines, for the prevention and treatment of wasting and nutritional oedema, refers to prioritisation criteria for children with moderate acute malnutrition at increased risk of non-recovery and death; therefore they should be prioritised. As selection criteria, it mentions individual and social factors to determine which children should receive therapeutic feeding.
Individual factors: MUAC 11.5 - 11.9 cm, Z-score weight/age <-3, age <24 months, severe personal circumstances (e.g. death of mother, among others), severe or chronic comorbidity (HIV, tuberculosis).
Contextual factors: high rates of food insecurity, unfavourable WASH indicators, high incidence/prevalence of wasting/nutritional oedema.

Additionally, they suggest that, depending on the possibility of ensuring adequate family feeding, some children with MAM may not need therapeutic feeding. Hence the possibility of prioritising according to the contexts and factors previously mentioned.

I hope this feeds the discussion.

Best regards.

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