Upload
bijan
View
76
Download
0
Embed Size (px)
DESCRIPTION
MAM Decision-making Tool. Meeting Objectives. Review the MAM decision-making tool Work through country situation Provide feedback on Content Usability Layout. Moderate Acute Malnutrition (MAM). Background Review of supplementary feeding programs (2007) - PowerPoint PPT Presentation
Citation preview
MAM Decision-making Tool
Review the MAM decision-making tool Work through country situation Provide feedback on
Content Usability Layout
Meeting Objectives
Background Review of supplementary feeding programs (2007) WHO consultations MMI (2008) and MMII (2010)
Dietary needs Programme approaches to manage MAM
NUGAG review on MAM Limited guidance on programming Differing approaches Increase in products available for programming
Moderate Acute Malnutrition (MAM)
CONFUSION!!!
Burden of MAM 11 million children affected globally 41 million children 3 x risk of death compared to well-nourished
Increased risk of acute malnutrition in emergencies
Moderate Acute Malnutrition (MAM)
Formed by the Global Nutrition Cluster UNHCR UNICEF WFP OFDA ACF Save the Children CDC
MAM Taskforce
Additional MembersWHOECHO
Guide practitioners to identify most appropriate and feasible strategies to address MAM Prevention Management (treatment)
Harmonize nutrition programme decision-making on MAM in emergency situations
Incorporate contextual situational factors into the decision making process Beyond nutritional status Engage in discussion
Tool Objectives
Decision making process grounded by data, but is subjective on some levels
Limited to emergency contexts Rapid/sudden onset Slow onset Protracted emergencies Acute emergency within a chronic emergency setting
Local or large-scale emergencies
Not for refugee contexts UNHCR/WFP Guidelines for Selective Feeding: The
Management of Malnutrition in Emergencies 2011 http://www.unhcr.org/4b7421fd20.pdf
Caveats of Tool
Primary objective: prevent morbidity and mortality associated with MAM
Linkages: MAM cannot be addressed in isolation SAM IYCF-E Other sectors (WASH, health, food security)
Re-assessment
Caveats of Tool
MAM decision tool steps
Step 1:Programme Type/Objective
Step 2:Modality
Step 3:Programme Operation
Step 4:Review and Revise
Prevention/treatmentPreventionTreatmentNo additional programme
Supplementary feedingCash/voucherInfant and Young Child Feeding
Target groupProductDurationDelivery
Regularly throughout the emergency
Prevalence of GAM in the affected area (current or historical)
Information nature and severity of the crisis (risk) Baseline health data in affected areas
Expected impact on morbidity Food security situation
Expected impact on food security Population data
Displacement Density
Data Needs
MAG scenarios for the tool High >15% Medium 8-15% Low <8%
Sources Trend data
Seasonality Admission data (coverage should be assessed) Screening data
Nutritional Data
Risk of Deterioration Analysis
Score Sum Score
Risk Category
Increased morbidity (acute watery diarrhea, measles, acute respiratory infections)
High 3
Score 6-8: HighScore 4-5 :MediumScore <3: Low
Medium
2
Low 1Food availability and/or access disrupted (markets, prices and/or production)
High 3Medium
2
Low 1Significant population displacement
Yes 1No 0
Populati0n density Yes 1No 0
Risk of Deterioration
Malnutrition Infection Cycle Likelihood of morbidity and/or outbreak to impact GAM Baseline data
Vaccination coverage, vitamin A coverage, disease profile WASH services Access to care
Morbidity
Risk of Deterioration
Analysis
Score
Increased morbidity • acute watery
diarrhea • measles• acute respiratory
infections
High 3 • Epidemic (outbreak)
Medium
2 • Increasing incidence• High levels
Low 1 • Stable incidence• Low levels
Magnitude, extent, severity and duration of the crisis on food security Household consumption and market data sources
Food Security
Risk of Deterioration Analysis
Score
Food availability and/or access disrupted (markets, prices and/or production)
High 3 • Extreme food consumption gaps
• Livelihood assets being depleted
• Irreversible coping strategiesMedium
2 • Significant food consumption gaps
• Irreversible coping strategies• Initial depletion of livelihood
assetsLow 1 • Food consumption reduced
• No deficient intakes• No negative coping
strategies
Influences type and frequency of programme Many different contexts and types of displacement
Dispersed settlements, mass shelter in collective centers, reception and transit camps, self settled camps, planned camps (official and unofficial), IDPs with host populations
Displacement
Risk of Deterioration
Analysis
Score
Significant population displacement
Yes 1 Displacement increasing and concentrated
No 0 • No displacement• No increase in displacement• Sparsely populated area
Risk of morbidity
Consider in programme delivery design Example: low GAM, but high density= large number of children
in need Haiti, post earthquake in Port au Prince Kenya, post election violence in urban centers
Population Density
Risk of Deterioration
Analysis
Score
Populati0n density Yes 1 • Urban area• Dense population
concentrationNo 0 All other areas
Risk of Deterioration Analysis
Score Sum Score
Risk Category
Increased morbidity (acute watery diarrhea, measles, acute respiratory infections)
High 3
Score 6-8: HighScore 4-5 :MediumScore <3: Low
Medium
2
Low 1Food availability and/or access disrupted (markets, prices and/or production)
High 3Medium
2
Low 1Significant population displacement
Yes 1No 0
Populati0n density Yes 1No 0
Risk of Deterioration
Programme Recommendations
MAM decision tool steps
Step 1:Programme Type/Objective
Step 2:Modality
Step 3:Programme Operation
Step 4:Review and Revise
Prevention/treatmentPreventionTreatmentNo additional programme
Supplementary feedingCash/voucherInfant and Young Child Feeding
Target groupProductDurationDelivery
Regularly throughout the emergency
Blanket Supplementary Feeding Provision of supplementary food Platform for other interventions
Screenings + referrals Child survival (deworming, vit A, immunisation) Health/nutrition education
Cash or Voucher Cash/voucher if food and nutrient availability is good,
markets functioning, caring practices maintained Further research needed
Specialised product + cash Cash 4X value of specialised product
Prevention: Modality
IYCF-E support
Infant & Young Child
Feeding in Emergenci
esComponen
t
Children under 5 at increased risk mortality Target children 6-59 months
If logistical constraints consider reducing target group PLW
No standard criteria for enrollment Impact on IYCF-E MAM treatment programming exist Low birth weight Prioritise
children over PLW lactating over pregnant women (protecting 0-6 month old infants)
Prevention: Target Group
BSFP should not be expanded to beyond 6-59 months and PLW except under serious conditions The general food distribution (GFD) should meet the needs of other household members.
Advocacy for improving the GFD or other food security measures.
Considerations Government approval Objective of the intervention & target group
Some products are targeted for 6-23/36 months Household’s ability to cook
Are there cooking facilities, easy access to fuel and water? Cultural practices and food preferences
Corn, wheat & rice based supercereals RUFs- peanut, chickpea and milk based (limited quantities)
Nutrient gap (energy & micronutrient) Decide upon higher or lower level energy
HH food security, diet diversity, baseline diets, chronic malnutrition, micronutrient deficiencies
Sharing practices, household use of foods, access to other foods
Prevention: Product
Product SheetNutrition Specialised Products
Product SheetNutrition Specialised Products
Target group Primary Recommendation
Interim/Alternative
Treatment of MAM6- 59 months RUSF
Supercereal PlusSupercereal/oil/sugar premix
PLW Supercereal/oil/sugarOlder Children Supercereal/oil/sugar RUSF or Supercereal
PlusPrevention of MAM6-23 or 6-59 months Supercereal Plus
LNS medium quantityRUSF±
Supercereal/oil/sugar½ sachet RUSF
PLW Supercereal/oil/sugar LNS medium quantity
Recommended Products and Alternatives
± Only where supplement is the primary source of available food
Duration of BSFP based on scale & severity of emergency GAM + Risk of deterioration
Generally 3-6 months Example start at least 1 month prior to leans season and run
until post-harvest Regular re-assessment
Scaling up or down Extension Rolling admission and no discharge (exiting) until end of
programme (even if child is older than upper limit at the close of programme)
Prevention: Duration and Exit Strategy
Considerations Access to the population
Security, seasonal, physical Scale of crisis (total area affected) Implementation capacity
Low or security- consider combining with GFD Population density
Determine number of sites If dense, may need multiple days/week for
distribution
Prevention: Delivery Mechanism
BSFP stand alone programme Targeted directly to households with children
BSFP Integrated delivery Child’s supplementary food is added to
food/cash/voucher distribution Low security context Rapid onset immediate programming Exclusion and inclusion errors Shift to parallel independent programme as soon
as feasible
Prevention: Delivery Mechanism
Targeted Supplementary Feeding (TSFP) Treatment for MAM with nutritious food supplement
and routine medical care Admission/discharge criteria based on anthropometric
measures (national or international guidelines) Nutrition communication Support for IYCF-E
Cash/vouchers need more evidence
Treatment
Malnourished children 6-59 months Discharges from SAM Pregnant and lactating (up to 6 months postpartum) women Chronic illness (HIV, TB)Exceptions Infants <6 months not admitted, support IYCF strengthened Other vulnerable populations identified (disabled children , 5-
10 years olds, older people)
Treatment: Target Group
Considerations Government approval Target group Household’s ability to cook
Are there cooking facilities, easy access to fuel and water?
Cultural practices and food preferences Corn, wheat & rice based supercereals RUFs- peanut, chickpea and milk based
(limited quantities)
Treatment: Product
Product SheetNutrition Specialised Products
Target group Primary Recommendation
Interim/Alternative
Treatment of MAM6- 59 months RUSF
Supercereal PlusSupercereal/oil/sugar premix
PLW Supercereal/oil/sugarOlder Children Supercereal/oil/sugar RUSF or Supercereal
PlusPrevention of MAM6-23 or 6-59 months Supercereal Plus
LNS medium quantityRUSF±
Supercereal/oil/sugar½ sachet RUSF
PLW Supercereal/oil/sugar LNS medium quantity
Recommended Products and Alternatives
± Only where supplement is the primary source of available food
Treatment range 1-4 months Scale down of TSFP considered when:
GAM <5% No aggravating factors Low numbers of admissions in MAM and SAM
treatment may also be used to decide to phase out Be mindful of programme coverage and
performance
Treatment: Duration and Exit Strategy
Considerations Access to the population
Security, seasonal, physical Scale of crisis (total area affected) Implementation capacity
Low or security- consider combining with GFD Population density
Determine number of sites If dense, may need multiple days/week for distribution
Treatment: Delivery Mechanism
Linked closely to treatment of SAM under CMAM model TSFP sites adjacent to OTP or health centres
support referrals (both directions) Large area for distribution/services If mobile or away from health centres provide
basic health interventions Considerations
Health service coverage, existing MAM/SAM programmes, capacity to scale-up
Treatment: Delivery Mechanism
Both prevention and treatment may be recommended Follow the previous steps to design each programme Think through linkages between programmes
Ideally, children should not be simultaneously enrolled in both programmes In reality, the risks associated with non-participation
outweigh the cost of dual participation In some large emergencies children should be enrolled in
prevention programmes as they may come in and out of treatment
Example: Northern Kenya, 2011/12
Prevention &Treatment
Additional programs not needed Existing nutritional programs
Re-evaluate risk as emergency progresses Build into nutrition response plan
Strengthen support for IYCF or micronutrient programmes
No Additional Intervention
Emergency programming is in addition to existing nutrition programmes
MAM decision tool steps
Step 1:Programme Type/Objective
Step 2:Modality
Step 3:Programme Operation
Step 4:Review and Revise
Prevention/treatmentPreventionTreatmentNo additional programme
Supplementary feedingCash/voucherInfant and Young Child Feeding
Target groupProductDurationDelivery
Regularly throughout the emergency
Programme LinkagesInterventions in emergencies:Addressing acute malnutrition
General Food
Distribution
Selective feeding
programmes
TreatmentTargeted
Inpatient treatment
PreventionBlanket feedingCash/voucher
Outpatient treatment
Treatment for SAM
MAM Programmes
IYCF-E
Addressing underlying causes of
undernutrition
Addressing micronutrient deficiencies
WASH
HealthFood
security
Josephine Ippe: Global Nutrition [email protected]
Lynnda Kiess: World Food [email protected]
My contact: Leisel Talley, Centers for Disease Control and Prevention:[email protected]
Additional Feedback