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Launch of CMAM Report – a global online monitoring and reporting application for CMAM programme

In Under-nutrition on August 27, 2015 at 8:24 pm

  (download doc)

CMAM Report is a comprehensive monitoring and reporting application with a global online data base that can be used to report on and monitor CMAM programmes with any of the following components: Stabilisation Centre (SC), Outpatient Therapeutic Programme (OTP), Targeted Supplementary Feeding Programme (TSFP), MUAC screening, supplies as well as Blanket Supplementary Feeding Programme (BSFP).

Click here to watch a 3 minute introduction to the software.

CMAM Report uses standardised reporting categories and indicators that were developed in close consultation with a steering group formed from the wider nutrition community – UN and leading nutrition agencies. If standardised reporting categories and indicators are applied, it makes data fully comparable between programmes as well as countries and agencies.

Join the CMAM Report webinar: Introduction to CMAM Report’s background, main functions and Q&A

Webinar option 1: 1st Sep 2015 at 2.30-4.30 pm (London time)   Join Lync Meeting

Webinar option 2:  9th Sep 2015 at 2.30-4.30 pm (London time) Join Lync Meeting

Example of reporting categories used in CMAM Report; see all categories here.

CMAM Report calculates unbiased performance indicators in accordance with the latest international standards, e.g. beneficiaries discharged from OTP are reported separately from regular MAM cases when entering TSFP.

The CMAM Report software:

  • Is a web based application with offline capacity for data entry
  • Is Open Source and free to use by all implementers of CMAM programmes: NGOs, UN and governments (license agreement need to be signed to use the software)
  • Can be used on desktop computers, laptops and tablets with any of the following browsers: Firefox, Google Chrome, Internet Explorer
  • Available in English and French – quick switch on each subpage
  • Gender reporting through all admission and discharge categories – if desired
  • Reporting on 6-23 months and 24-59 months age groups – if desired
  • Grant reporting, stock and stock out tracker, AWG/LOS calculator
  • Creates summary tables and graphs (as PDF,Word, Excel) by feeding site, group of feeding sites, geographical location up to global level, e.g. East Africa or global
  • Raw data export to Excel and on to statistical software
  • Real-time check for data entry mistakes
  • Warning on suboptimal performance per site; check against Sphere standards
  • Hierarchy and approval system from data entry at field level via country level to HQ
  • Access for MoH and UN agenciesto view and analyse data entered by all CMAM implementers in a given country (Country Admin function)

For further resources and more information please visit www.cmamreport.com.

For any questions or to test the software please write to cmamreport@savethechildren.org.uk or request your Demo version logins here.

CMAM Report was developed by Save the Children and is funded by the Humanitarian Innovation Fund (HIF).  See all Acknowledgements.

UNICEF – 2013 Global: Evaluation of Community Management of Acute Malnutrition (CMAM): Global Synthesis Report

In Under-nutrition on March 29, 2014 at 5:29 am

from UNICEF web page

Executive summary

(download)

Background:

Approximately 20 million children are affected by severe acute malnutrition (SAM) worldwide – some residing in countries facing emergencies and many others in non-emergency situations. Children suffering from malnutrition are susceptible to death and disease and they are also at greater risk of developmental delays.
Treatment of SAM has evolved as a major development intervention over several decades. Alongside other partners, UNICEF works to ensure that women and children have access to services, including through timely provision of essential supplies – especially therapeutic foods for the treatment of SAM. The advent of ready to use therapeutic food (RUTF) and a community-based approach – community management of acute malnutrition (CMAM) – has made it possible to treat the majority of children in their homes.
CMAM is generally a preventive continuum with four components: 1) community outreach as the basis; 2) management of moderate acute malnutrition (MAM); 3) outpatient treatment for children with SAM with a good appetite and without medical complications; and, 4) inpatient treatment for children with SAM and medical complications and/or no appetite. A key objective of CMAM is progressive integration of all four preventive components into national health systems. By the end of 2012, governments in 63 countries had established partnerships with UNICEF, WFP, WHO, donors, and NGO implementing partners (IPs) for CMAM. The Ministries of Health (MoH) assume leadership and coordination roles and provide the health facilities.
UNICEF’s inputs for CMAM include policy development, commitment of funds, coordination, and technical support available to the MoH and other implementing partners. UNICEF has made significant investments to scale up treatment of SAM through CMAM including procurement of therapeutic foods, medicines, and equipment. UNICEF currently procures approximately 32,000 MT of RUTF annually which represents an investment of over 100 million dollars.

Purpose/ Objective:

This evaluation is the first systematic effort by UNICEF to generate evidence on how well its global as well as country level CMAM strategies have worked, including their acceptance and ownership in various contexts and appropriateness of investments in capacity development and supply components. The evaluation was conducted by a team of independent external evaluators and included comprehensive assessments of CMAM in five countries (Chad, Ethiopia, Kenya, Nepal and Pakistan) and drawing synthesized findings and recommendations based on broader research and a global internet survey targeting all countries implementing CMAM. A wide range of stakeholders, including national and international partners, beneficiaries, and donors, participated in the exercise. The resulting conclusions and recommendations are intended to strengthen UNICEF’s contributions to CMAM and to support governments, UN agencies, NGOs and other stakeholders in modifying CMAM policy and technical guidance for both emergency and non-emergency contexts.

Methodology:

The evaluation scope consists of two interrelated components. First, the evaluation undertook detailed analyses of CMAM in Chad, Ethiopia, Kenya, Nepal and Pakistan. The criteria of relevance, effectiveness, efficiency, sustainability and scaling up were applied to CMAM components and to cross-cutting issues. Data were obtained from secondary sources, health system databases, and observations during visits to CMAM intervention areas. The community perspective was analysed through collection of opinions from caretakers, extended family, community leaders, and community-based health workers in addition to stakeholders from government and assistance agencies. Quantitative data were analysed to determine whether performance targets were met and qualitative data supported the analysis. Secondly, building upon case study evidence, broader research resulted in compiled lessons, good practices and recommendations for UNICEF and partners globally. A global internet survey targeting all 63 countries implementing CMAM, helped to triangulate and validate conclusions from the five country case studies.

Findings and Conclusions:

1. Relevance of CMAM Guidance and Technical Assistance
• The CMAM approach is appropriate to address acute malnutrition, particularly to the degree that CMAM is being sustainably integrated into the national health system.
• Demand for CMAM services has increased; efficient use of community resources for prevention and identification and referral of children with MAM and SAM contributes to demand.
• National contributions to CMAM are growing but scale up (expansion) is challenged by funding constraints for regular programming and reliance on emergency funds and external sources of assistance.
• Global UNICEF and WHO guidance for SAM treatment has contributed to development of national guidelines which offer high value in promoting district ownership. However, lack of agreement on the best approach to address MAM has contributed to inconsistency among countries for MAM management and concomitantly, prevention of SAM.
• Global and national guidance is generally adequate for treatment protocols but lacking or fragmented regarding: planning and monitoring, integration of CMAM, equity and gender, community assessment and mobilization, and MAM management.
• Technical support has resulted in significant gains in process, coverage and outcomes; creation of parallel systems is not sustainable and slows national ownership.
• Within UNICEF overall, there has been effective support for fund mobilization, emergency nutrition response, and supporting nutrition protocols; expansion of regional roles is important to meet national technical assistance needs.
• Capacity development has significantly promoted quality of services […]

2. CMAM Effectiveness and Quality of Services

3. Promoting Equity in Access

4. Progress and Issues related to National Ownership

5. Efficiency – Costs, Supply and Delivery of RUTF

6. Sustainability and Scaling Up (Expansion of CMAM)

[see Executive Summary for more information]

Recommendations:

Overall, the evaluation recommends that UNICEF continue to promote and support CMAM as a viable approach to preventing and addressing SAM, with an emphasis on prevention through strengthening community outreach and integrating CMAM into national health systems and with other interventions.

Ownership and Integration, Strategy and Policy, Guidelines
• UNICEF should continue to work with governments, WFP, WHO, IPs, and other stakeholders to secure a common understanding on the most effective means of addressing MAM in order to unify approaches, to strengthen community-based preventive measures, and to prevent SAM and relapses into SAM.
• Establish a guideline or framework for integration of CMAM into the health system and with other interventions that is useful at national level when based on capacity assessments and integrated with national health, nutrition and community development strategies.
• Facilitate coordination and technical support at regional/national level to expand or develop national CMAM guidelines as CMAM is integrated with other interventions such as IYCF.

Performance and Quality of Services
• Strengthen community outreach by ensuring adequate investment in CMAM awareness raising activities and their integration with outreach for other public health interventions.
• Decentralize nutrition information systems to strengthen data collection and analysis at district level supporting and reinforcing the MoHs’ lead role and joint accountability among the MoH and partners for improving quality.
• Define a standardized monitoring system to assess the quality of the CMAM services to inform the MoH, UN partners, IPs and other stakeholders where more capacity is needed.

Equity in Planning and Coverage
• Strengthen planning for CMAM through conducting community assessments, and greater use of joint integrated results-based planning exercises and mapping information […].

Finally! Everything, really everything, about treatment of undernutrition (CMAM). In just-one-click-away, comprehensive, interactive, open-access, website.

In Under-nutrition on July 10, 2012 at 10:42 am

A new electronic forum improves the management of acute malnutrition. Worldwide.

In this area of humanitarian intervention, CMAM is the acronym mostly used: Community-based Management of Acute Malnutrition.

The CMAM forum not only hosts e-discussions about this topic, but also collects all the key documents endorsed by the WHO, other UN agencies, national and international NGOs. Otherwise scattered around, in their web sites.

World experts in this field (Andre’ Briend, and Mark Myatt among them) support this forum. Therefore, the target consists of practitioners rather than the general public.

The main focus list of the e-forum includes:

  • malnutrition and HIV/AIDS
  • malnutrition and infants, children, adolescents and adults, whose specificities are treated separately
  • malnutrition and health systems in the individual countries
  • evidence for action aiming policy-making, advocacy, support in the area of malnutrition treatment
  • product development for malnutrition rehabilitation
  • current research and existing evidences about most of the topics mentioned above
The web site has important tools:
  • you are interested in CMAM in a specific country? Visit the country section of the CMAM web forum
  • you wish to receive notices about meetings, conferences, trainings? You want to ask questions, learn how to calculate case loads, or simply follow up other people’s questions? Create your website account (for free)
  • you are interested in the latest evidence-based documents or the current state of research? Visit the related section of the forum
  • you can also contribute sharing, with the other forum members, the lessons learnt from your community-based feeding programme

This important forum was conceived thanks to the effort of many organizations. However, the realization was led by Valid International and Action Against Hunger.

If you find the CMAM forum interesting, do not hesitate to re-blog this post, or forward the link of the forum to relevant people.

If you have some constructive criticism or ideas to improve this new important tool, I encourage you to contact its coordinators: Nicky Dent and Rebecca Brown (contacts): I promise that they will be extremely happy to hear from you…

Use of Innovative Information and Communication Technology in Nutrition Service Delivery

In Under-nutrition on January 11, 2015 at 2:48 pm

By Steve Ollis (D-tree International)

 CMAM-Forum Technical Brief no. 14

with the support of

the European Commission and UNICEF

(download the complete report)

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Hybrid public/private delivery of preventative Lipid-based Nutrient Supplement products

In Under-nutrition on November 14, 2013 at 11:31 am

If you are interested in the implications of the delivery mechanisms of the LNS products, do not miss this paper published on the SCN News Bullettin, by Travis J.Lybbert, UCDAVIS.

(download)

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Managing acute malnutrition at scale – A review of donor and government financing arrangements (Network Paper Issue 75)

In Under-nutrition on June 1, 2013 at 10:00 am
Published on 20 May 2013
Introduction

This review is concerned with the financing arrangements for programmes that address acute malnutrition at scale through the community-based management of acute malnutrition (CMAM). The CMAM approach is geared towards the early detection, treatment and counselling of moderately and severely acutely malnourished children, in the community, by community agents.

Until the late 1990s, treatment of severe acute malnutrition (SAM) was through therapeutic feeding centres in hospitals and healthcare centres. Performance was poor, coverage was extremely limited (less than 5% of the SAM population), mortality was often in excess of 30% and recovery rates were low. The CMAM approach was first piloted in Ethiopia in 1999 as an alternative to the centre-based model.
Development of the approach offered the prospect of dramatically increased access to successful treatment and coverage.

CMAM has been adopted in over 65 countries. In 2011, just under two million children under five years of age with SAM were reported as being admitted to CMAM programmes, compared with just over one million in 2009.1 While this large increase partly reflects improved reporting, it is also indicative of the ongoing scaling up of treatment of SAM. Even so, total reported admissions represent just 10–15% of the estimated 20m global SAM cases annually.

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Semi-Quantitative Evaluation of Access and Coverage (SQUEAC)/ Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC) Technical Reference (2012)

In Under-nutrition on May 26, 2013 at 9:07 am

from FANTA web site.

FANTA, in collaboration with Valid International, Action Against Hunger, Concern Worldwide, Tufts University, and Brixton Health, has developed a technical reference guide for two new low-resource coverage assessment methods for evaluating access and coverage of Community-Based Management of Acute Malnutrition (CMAM) and other selective feeding programs.

The first method—Semi-Quantitative Evaluation of Access and Coverage (SQUEAC)—combines routine program monitoring data, an array of qualitative information, and small-sample quantitative surveys. This combination is used to identify key issues affecting timely presentation at a clinic program uptake and provides an estimate of the level of program coverage achieved. SQUEAC can be used in real time, allowing the collected data to be of immediate practical use to adjust program design and implementation.

The second method—Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage (SLEAC)—is a small-sample quantitative method. The keys features of SLEAC are simplicity, low cost, and versatility. SLEAC can be used to map and estimate coverage over large areas.

The report is available for download in whole or parts. If you have difficulty downloading the PDFs, please send an email to fantamail@fhi360.org with your mailing address and we can send you the files via CD-rom.

PDF icon Download the report [7.09 mb]

Mobile phone technologies to improve the prevention and treatment of malnutrition?

In Under-nutrition on August 23, 2012 at 8:56 am

Source: Rapid SMS – http://www.rapidsms.org/

In 2011, WHO reports:

The use of mobile and wireless technologies to support the achievement of health objectives (mHealth) has the potential to transform the face of health service delivery across the globe.

A powerful combination of factors is driving this change. These include rapid advances in mobile technologies and applications, a rise in new opportunities for the integration of mobile health into existing eHealth services, and the continued growth in coverage of mobile cellular networks.” (download the entire doc)

(To learn more about m-Health, read this paper from the WHO Bulletin: Point of care in your pocket: a research agenda for the field of m-health)

The same WHO document mentions a wide range of  applications, but regretfully does not include the treatment or the prevention of malnutrition, although the potential is there. These are few examples:

  • In Kenya, in 2009, the Millennium Villages Project and the Columbia University looked into the use of SMS to support the community-based management of acute malnutrition in children under five. The pilot study concludes that “an
 SMS
 based
 approach,
 using
 a
 system
 like
 ChildCount,
 can
 lead
 to
 improved
 maintenance
 of
 child‐specific
 anthropometric 
records
, which 

effectively 
help in 
monitoring 
a 
community’s
 health”
 (see the entire doc)
  • In Malawi, more recently, “UNICEF deployed SMS to address serious constraints within the national Integrated Nutrition and Food Security Surveillance (INFSS) System, which was facing slow data transmission, incomplete and poor quality data sets, high operational costs and low levels of stakeholder ownership.  Health workers now enter a child’s data, and through an innovative feedback loop system, Rapid SMS instantly alerts field monitors of their patients’ nutritional status. Automated basic diagnostic tests are now identifying more children with moderate malnutrition who were previously falling through the cracks.  This system also increased local ownership of the larger surveillance program through two-way information exchange.  Operational costs for the Rapid SMS system are significantly less than the current data collection system. The Government of Malawi is considering a national scale-up later this year” (read more here)
  • In the last 2 years, the same organization (Rapid SMS) has successfully piloted in Ethiopia a RUTF stock reporting and request system. This has the potential for improving the communications of stock levels and requests up the supply chain and consequently for avoiding supply breaks (more info here at page 42, and here)
  • WFP focuses on the prevention and treatment of moderate acute malnutrition and has also been involved with innovations using cash/vouchers and SMS for monitoring the implementation of programmes and for monitoring cases of malnutrition (read more at page 24 of this document)
  •  In 2011, UNICEF and Valid International undertook a “Global Mapping Review of Community-based Management of Acute Malnutrition” (with a focus on Severe Acute Malnutrition). In countries of interest, the same document suggests a review of innovative technologies to improve information flow to national level. Those include the use of Rapid SMS to improve timeliness and quality of reporting.  “Many countries have started or are recommending use of Rapid SMS“, because “the large number of centres makes compilation & transmission difficult”. For this reason, moving “towards Rapid SMS to improve transmission” is crucial.

Some of the organizations with promising capacities to design SMS platforms, and helping in fighting malnutrition, are listed here:

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Note that:

the Forum on Community-based Management of Acute Malnutrition will be preparing a more detailed Technical Brief on the subject of M-health and E-health in the coming months.

Feel free to contact the Forum, if you are interested in m-health & nutrition, or in any other aspect related to Community-management of Acute Malnutrition.

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Question: you know any other experience in this area of nutrition and m-health? Worth reporting on this blog? Please, share that: leave a comment (down here), or contact me.

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Save the Children (NGO) about treatment of Acute Malnutrition: Minimum Reporting Package User Guidelines

In Under-nutrition on August 21, 2012 at 10:46 am

(download the entire doc)

“These minimum Reporting Package (MRP) User Guidelines are intended to outline the definitions, reporting categories and performance indicators for monitoring and reporting on three feeding programmes using the MRP software.

“The programmes are: targeted Supplementary Feeding Programmes (SFPs), Outpatient Therapeutic Programmes (OTPs) and Stabilisation Centres (SCs).

“There is also guidance on interpreting and taking action on programme performance indicators.

“The audience for the guidelines are nutrition programme coordinators and M&E staff of NGOs involved in the monitoring and reporting process.”

On this blog you can find more information about management of acute malnutrition, and ready to use foods for undernutrition treatment.
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Randomized, Double-Blind, Placebo-Controlled Trial Evaluating the Need for Routine Antibiotics as Part of the Outpatient Management of Severe Acute Malnutrition

In Under-nutrition on August 11, 2012 at 11:23 am

by Mark J. Manary, Kenneth Maleta, Indi Trehan
Food and Nutrition Technical Assistance II Project (FANTA-2) Bridge, FHI
360, March 2012

(download the entire document)

The Food and Nutrition Technical Assistance (FANTA) Project undertook a clinical trial comparing nutritional recovery and mortality outcomes in children with severe acute malnutrition (SAM) receiving 1 week of amoxicillin, cefdinir, or placebo, in addition to usual peanut-based ready-to-use therapeutic food (RUTF) therapy. This report documents the outcomes of the trial, which clearly showed the benefit of using antibiotics in the outpatient treatment of SAM without medical complications in a setting with high levels of kwashiorkor and HIV infection.

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