Community-Based Management of Acute Malnutrition Coverage Evaluations

By Muthoni Njage MPH , Wamuyu Maina PhD and Christina Blanchard-Horan PhD,

Evaluation of nutrition programs often involves a close look at Community-Based Management of Acute Malnutrition (CMAM).  This nutrition program responds to acute malnutrition or wasting.

Acute Malnutrition is a severe and life-threatening form of malnutrition. It occurs when a person loses too much weight or muscle mass and their body can no longer function properly. CMAM is a community-based approach to managing acute malnutrition in the community. This means that communities are involved in identifying and treating cases of acute malnutrition, as well as preventing new cases from occurring. CMAM programs are typically run by NGOs, but can also be run by governments or other organizations.

CMAM programs are not always done using the same model. Although there are guidelines.  The success of CMAM programs is typically measured by the number of children who are successfully treated for acute malnutrition and the number of new cases that are prevented. CMAM programs have been shown to be effective in reducing the incidence of acute malnutrition, as well as improving the overall health and nutrition of communities. 

World Food Program to learn more about the types of malnutritions   at the World Food Program 2016 publication

CMAM Method

Since 2007, the Community-Based Management of Acute Malnutrition (CMAM) through UNICEF and partners has expanded to more than 55 countries. The CMAM method promotes use of ready-to-use therapeutic food (RUTF). The CMAM model requires direct assessment and monitoring of “coverage.” Key determinants of impact are the degree to which interventions treat people early and the ability to spread treatment to as many affected persons as possible. (Myatt, et al., 2012)

Reaching out at scale to all the vulnerable groups with essential nutrition services remains a challenge.  (Lutter, et al., 2011) Many factors like inadequate human resources, poor nutrition knowledge, and capacity within the health system to manage a nutrition program, high workloads, etc., result in low coverage of nutrition services. In countries like Sierra Leone, childhood illnesses, insufficient service coverage, quality and demand for health services (exacerbated by several Ebola outbreaks), and poor sanitation remain the major causes of child undernutrition.  (Lutter, et al., 2011; West, Saint, & Arnim, 2014)

Measuring CMAM

In 2005, World Food Program and the Centers for Disease Control and Prevention (CDC) published Measuring and Interpreting Malnutrition and Mortality , which provides indices and other guiding information about identifying and measuring malnutrition. It also includes a randomization table, health surveys, and index z-score charts.

Since then, recognized survey methods have emerged and have been tested by the Coverage Monitoring Network. For CMAM Coverage Evaluations, methodological choices vary by the desired outcome.

CMAM Indices

The CMAM Coverage Evaluation toolkit provides indices and other guiding information about identifying and measuring malnutrition. It includes a randomization table, health surveys, and index z-score charts. The CMAM Coverage Evaluation toolkit is used to evaluate the success of CMAM programs.

The CMAM Coverage Evaluation Toolkit is used to measure:

– The number of children who are successfully treated for acute malnutrition

– The number of new cases that are prevented

– The overall health and nutrition of communities

CMAM programs have been shown to be effective in reducing the incidence of acute malnutrition, as well as improving the overall health and nutrition of communities.

Anthropomorphic Indices for malnutrition

1. Height for age
2. Weight for age
3. Weight for height

Other Indices

1. Anemia: Hemoglobin
2. Vitamin A Deficiency: Night Blindness and/or Serum Retinol
3. Iodine Deficiency: Urinary Iodine
4. Complications – Oedema http://www.unhcr.org/45f6abc92.pdf)

Indicators of Low Coverage

The two indicators of low coverage are “length of stay at admission” and “rate of default, i.e. people who do not return for follow up care, or failures who don’t go for care when referred.  Furthermore, researchers continue to refine these models as more information is learned and to adjust for contextual experiences, as outlined below.

Coverage Survey Types

1) Centric Systems Area Sampling (CSAS), which is a resource intensive coverage survey that provides strong spatial resolution of surveys. Outputs include overall coverage estimate, local coverage, and ranked barriers.

2) Simple Spatial Survey Method (S3M), which designed for wide area coverage, is a Simple Spatial Survey, providing a simple assessment “general survey method” used to survey and map coverage and prevalence. It is not designed to cover three program levels or to determine levels of accessibility and utilization. Outputs include coverage map, overall estimate of coverage and ranked barriers.

3) Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC), a rapid low-cost survey using spatial sample similar to CSAS, requiring small sample sizes. Outputs include overall coverage classification, local coverage classifications with coverage map and wide area “estimates”, as well as ranked list of barriers.

4)  Semi-Quantitative Evaluation of Access and Coverage (SQUEC), a method of evaluating effectiveness, coverage, and ability to meet need. Provides overall coverage estimate and rich information on barriers and boosters to coverage. Outputs include mapping of coverage using “risk map” approach, estimation of coverage using Bayesian techniques, concept map of barriers and boosters to coverage.

These are important because research is showing that the use of these methods on a regular basis is improving CMAM coverage to 75% to 80%. (Myers, et al).

GHL Solutions Nutrition Team

Summary

The CMAM Coverage Evaluation Toolkit is used to measure the success of CMAM programs in reducing the incidence of acute malnutrition and improving the overall health and nutrition of communities. The toolkit includes indices for identifying and measuring malnutrition, as well as a randomization table, health surveys, and index z-score charts. CMAM programs have been shown to be effective in reducing the incidence of acute malnutrition, as well as improving the overall health and nutrition of communities.