The Community-based Management of Acute Malnutrition - CMAM

The Community-based Management of Acute

MalnutritionAddis AbabaNovember 2011

Dr Steve Collins

Valid Nutrition / Valid International

STUNTING NORMAL WASTING (CHRONIC) (ACUTE)

Picture copyright Prof Michael Golden

NORMAL Low weight for age Low weight for age

Low height for age

Low MUACLow weight for

Picture copyright Prof Michael Golden

Severe Acute Malnutrition is important

> 20 million children affected at any one

time

1-2 million deaths annually

Evidenced based, highly cost effective

management available

Very high mortality associated with SAM

Mortality of children with severe acute malnutrition observed in longitudinal studiesCountry Mortality rateDemocratic Republic of the Congo 21%

Bangladesh 20%Senegal 20%Uganda 12%Yemen 10%

Ref WHO 2007

Hospital-based clinical approaches were

resource intensive and low impact

Early presentation

Treating people as active consumers

of services provided new

insights

Demand Driven Delivery

THE CMAM model

Delivery

Product

Focus on simplicity

Upgrading local food industries

RUTF recipes using range of locally

grown crops

Ingredients purchased from small farmers

Link treatment with prevention – local production of RUTF

Delivered through local clinics and networks

High recovery21 programs implemented in Malawi, Ethiopia Sudan &

Niger between 2001 - 2005

~78% no inpatient care

3.3% transferred & 2.3% non-recovered

N recovered died defaulted

23,511 79% 4% 11%

Lancet 2006

Cost Effective

Cost outcome Bangladesh 2011

Ethiopia 2007

Malawi 2009

Zambia 2009

Recovery $180 $145

Case treated $165 $203

DALY $26 $42 $53

Sadler et al 2011

2004-2005 baseline U5 years (DOWA)= 33.4 per 1000 children/years

Low relapse

Mortality 15 months post discharge from CMAM in Malawi

Bahwere et al 2009

Endorsement of community-based treatment of malnutrition as preferred intervention approach

WHO

by 2010 present in 55 countries>1,000,000 cases of Severe Acute Malnutrition

treated annually

Demand for Ready to Use Food

SAM related nutrition commodities ordered by UNICEF country offices( ref Duke University / UNICEF 2009)

RUTFHospital Milk products

Challenges of scale-up

Transition from emergency to standard element of primary health care Funding cycleCapacity of health system Staff training – lead time for pre-service training Logistic capacity to deliver RUTF

Impact & EvidenceCoverage assessment Impact & Cost effectiveness The rush to innovate

Developmental model for CMAM Promotion of “food aid” solutions Lack of independent accreditation / certification body Access to locally produced RUTF

•UNICEF purchases at least 50% global supplies. (UNICEF, MSF and Clinton Foundation approximately 80% )

•Total market at end 2010 estimated at 32,000MT

UNICEF global purchases of RUTF 2000 - 2010

RUTF MARKET

RUTF manufacturing capacity 2011 (MT)

40,140

0

32,600

40,400 73000

Developing country manufacturing capacityDeveloped country manufacturingOther developed countryUS manufacturing capacity installed in past 2 years

Data UNICEF 2011

Conclusion - CMAM is:

Evidence based developmental model to treat SAMDemand drivenHigh ImpactCost effectiveAn integrated approach to undernutritionIssues in transition to primary health careFunding cycles Impact monitoring - coverageTraining and logisticsUnder threat Supply side “food aid” model of AIDCo-option of name to fund poor practice

THANK YOU

Dr. Steve Collins,

Valid Nutrition / Valid International

+353 87 219 5560

steve@validinternational.org

www.validnutrition.org

www.validinternational.org