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CMAM Community BasedManagement Of
Acute Malnutrition
HABIB UR REHMAN
Program Coordinator
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Objectives of Program
OThe overall objective of CMAM is to save livesof malnourished
children 6-59 months and
PLWs by improving nutritional status throughprovision of
effective nutritional services at thecommunity and facility
level.
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Components of CMAM1. Community outreach: Community
Mobilization and Screening (through MUACat Community Level
2. Outpatient therapeutic program (OTP):(6-59month) SAM without
complication
3. Supplementary feeding program (SFP):
MAM children & PLWs at risk4. Inpatient care: (6-59 months
)SAM with
complication
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Supplementary Feeding
Programs (SFP)O Children aged 6-59 months with moderate
acute malnutrition. (MUAC 11.5-12.4) with
appetite and without medical complications.
OAcutely malnourished pregnant women in thesecond and third
trimester. (MUAC
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Who is qualified to run SFP
?O SFP can be operated by anyone who can
read and write, can accurately interpret
and record data. LHWs are best option.
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Basic SuppliesO Supplementary ration (Acha MUM, HEB,
WSB, Oil)O
Registration forms for children, pregnant andlactating womenO
SFP Ration cardsOTransfer slip to OTPO
Key messages for SFPO Essential medicinesO Water, cup and spoon
to give medicines
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Enrolment Procedure
STEP 1
1. Measure MUAC.
2. Check for edema. If there is bilateraloedema refer to
OTP.
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Oedema Case
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Enrolment Procedure
Step 2
O If the child meets the criteria for SFP.
O Explain the purpose of the treatment to the
caretaker of the child or PLWs.
O Register the child or pregnant or lactatingwoman.
O Complete the admission form of the SFPration card and assign a
number.
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Enrolment Procedure
Step 3
O SFP take home ration is given. This is intendedto supplement
the diet taken at home.
O Routine medication
O Ensure the SFP card is completed (themother / caretaker takes
the card home and
brings it back next visit).
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Enrolment Procedure
Step 4; key messages
O Clear advice must to be given tomothers caretakers on how to
prepare
the ration.
O Where possible, preparation andcooking demonstrations should
be
given at the SFP site or in thecommunity.
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O Ensure the mother/caretaker understandsthat the ration is
intended for the
malnourished individual and is not to beshared.
O Explain how to store the ration safely.
O
Make sure the mother / caretaker knowswhen to return to the
SFP.
Enrolment ProcedureStep 4; key messages
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SFP follow-up visits
O Children and mothers should attend the SFPevery month or every
two weeks for monitoringand to receive their supplementary
ration.
O Each visit the MUAC is measured, the oedemachecked.
O Children with apparent medical complicationsshould be referred
to in-patient care (or thenearest health facility if this is not
practical).
O Children who are admitted to SFP and thendeteriorate and meet
entry criteria for OTPshould be transferred to OTP.
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Exit CriteriaO Children 6-59 months = MUAC>12.5
AND Minimum 3 months stay in theprogramme
O Pregnant and lactating women = MUAC>21AND Minimum of 3
months stay in
programme
O Maximum 4 months stay in programme.
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Before
Treatment
After
Treatment
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Before
TreatmentAfter
Treatment
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Others Reasons for SFP
Enrolment:O Children discharged from OTP: Children who
have completed treatment in OTP should beenrolled in SFP.
O Readmission: Children who have beendischarged from SFP and
then meet the criteriafor enrolment again are counted as
newenrollees.
O
Return after default: Children who return afterdefaulting
(absent more than one visit if SFP isevery month or two visits if
SFP is every two
weeks).
