The Community-based Management of Acute Malnutrition Addis Ababa November 2011 Dr Steve Collins Valid Nutrition / Valid International
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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
www.validnutrition.org
www.validinternational.org
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