evidence-based blog of Filippo Dibari

Posts Tagged ‘acute malnutrition’

NO WASTED LIVES: the research agenda

In Under-nutrition on April 3, 2018 at 8:20 pm

from the webpage of No Wasted Lives

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The No Wasted Lives Coalition is investing in cutting edge ideas to drive forward global learning and action on acute malnutrition. As part of this effort, in 2018, No Wasted Lives and the Council of Research & Technical Advice (CORTASAM) launched the global Research Agenda for Acute Malnutrition and a call for Expressions of Interest from organisations working in research and programming for acute malnutrition and who want to support this effort. Our aim is to support coordination and concrete action across the sector, filling critical gaps and scaling-up evidence-based prevention and treatment of acute malnutrition.

 

Prioritising Research for Impact

The Council for Research and Technical Advice on Acute Malnutrition (CORTASAM) was assembled under No Wasted Lives with the goal to drive the use of evidence for action, in order to ultimately reach more children with effective treatment and prevention programmes.

Over the course of 2017, CORTASAM and No Wasted Lives launched a research prioritisation exercise, with the involvement and contribution of over 300 individuals from national governments, NGOs, academia, UN agencies and technical experts from around the world. In line with the priority research areas identified and a review of the existing evidence, CORTASAM has identified the following research areas with high potential impact on the effective management of acute malnutrition at scale but where further research and evidence generation is critically needed in order to achieve this:

  1. Effective approaches to detect, diagnose, and treat acute malnutrition in the community: taking community detection using mid-upper arm circumference (MUAC) to scale while building the evidence on diagnosis and treatment of acute malnutrition in the community across contexts and health platforms.
  2. Appropriate entry and discharge criteria for treatment of acute malnutrition to ensure optimum outcomes: building the evidence base on expanded MUAC thresholds for treatment to improve treatment outcomes for all children with acute malnutrition. Also needed is research to explore different options to identify high-risk children not selected by MUAC<115mm and analysis on the impact on burden estimates and operational feasibility, including supply and supply chain.
  3. Optimum dosage of ready-to-use food (RUF) for treatment of acute malnutrition:  investigating the safety, effectiveness, and cost-effectiveness of reduced dosage of RUF for treatment of acute malnutrition.
  4. Effective treatment of diarrhoea in children with severe acute malnutrition (SAM): using evidence to streamline guidance and generating implementation research to understand how the operational application of guidelines can inform improved practice and better treatment outcomes.
  5. Rates and causal factors of post-treatment relapse across contexts: understanding the burden of relapse post-treatment and, if found to be high, effective solutions to reduce relapse across contexts.
  6. Identification and management of at-risk mothers and of infants <6 months of age: generating the evidence required to influence country-level policies and implementation at scale.
  7. Alternative formulations for ready-to-use foods for acute malnutrition: continuation of the large amount of ongoing research to investigate the effectiveness, and cost-effectiveness, of formulas using alternative and local ingredient.

More details about the evidence gaps and CORTASAM’s call for more research can be found in the Research Agenda. Download it below.

 

 

In January 2018 we ran a call for Expressions of Interest in response to the Research Agenda. The call closed in February 2018 and applications are now being considered for possible donor funding. Download an overview of the submissions received here.

People-in-Need/Nutrition: (free) operational resources for not-necessarily nutritionists

In Under-nutrition on April 2, 2018 at 9:40 am

from People-in-Need webpage

(click on the covers of the publications to download them)

Nutrition Surveys


Nutrition programming
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SBCC toolkit
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UNICEF/WHO/WB: Levels and Trends in Child Malnutrition

In Over-nutrition, Under-nutrition on June 7, 2017 at 7:02 pm

source: World Bank webpage

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(download)

In May 2017, UNICEF, WHO and World Bank Group released the 2017 edition of the joint child malnutrition estimates for the 1990–2016 period, representing the most recent global and regional figures. A suite of on-line interactive dashboards were developed to enable users to explore the entire time-series (1990 – 2016) of global and regional estimates of prevalence and number affected for stunting, overweight, wasting and severe wasting. These estimates are presented by various regional and income group country classifications used by various agencies including the United Nations, UNICEF, WHO and The World Bank Group.

Note: Global estimates refer to the aggregate of the UN regions.

Characteristics and determinants of child malnutrition in Mozambique, 2003–11

In Uncategorized on December 19, 2016 at 1:36 pm

Cardoso, J., Allwright, L. & Salvucci, V. (2016) Characteristics and determinants of child malnutrition in Mozambique, 2003–11. 2016/147. Helsinki: UNU-WIDER.

(download pdf)

Child malnutrition continues to be a serious impediment to development both at the individual and national levels in many developing countries. In Mozambique, despite a high and sustained GDP growth, child malnutrition has been decreasing at a rather slow pace over the past 15 years.

In this study, using the Mozambican Demographic and Health Surveys 2003 and 2011 we find that household wealth, mother’s education, area of residence, and access to safe water and improved sanitation facilities have a strong relation with different measures of chronic child malnutrition.

Also, the relative importance of these variables remained mostly unchanged over time.

We conclude that continued and more focused and effective interventions aimed at directly reducing child malnutrition should be undertaken by all public and private actors involved.

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.

ENN: The relationship between wasting and stunting: policy, programming and research implications (2014)

In Under-nutrition on April 24, 2015 at 6:16 am

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by Tanya Khara and Carmel Dolan – from ENN website

Download – (4.2mb)

This paper is a narrative review of the available literature on the relationship between wasting andstunting. It was born out of previous work carried out by the ENN which illustrated the divide at programme, policy and financing level between wasting and stunting.

This divide ultimately has profound implications for how children worldwide receive nutrition interventions and services and, may well contribute to the lack of nutritional impact seen in programmes only addressing one part of the undernutrition problem.

Gaining a clearer and common understanding of the relationship between wasting and stunting has the potential to help governments and supporting organisations to better justify, design and evaluate programmes to improve childhood nutrition.

This paper aims to contribute to that clearer and common understanding.

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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They starved so that others be better fed: remembering Ancel Keys and the Minnesota experiment.

In Under-nutrition on June 3, 2014 at 1:51 pm

by Kalm LM, Semba RD.

 J Nutr. 2005 Jun;135(6):1347-52

(download)

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Abstract

During World War II, 36 conscientious objectors participated in a study of human starvation conducted by Ancel Keys and his colleagues at the University of Minnesota. The Minnesota Starvation Experiment, as it was later known, was a grueling study meant to gain insight into the physical and psychologic effects of semistarvation and the problem of refeeding civilians who had been starved during the war.

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During the experiment, the participants were subjected to semistarvation in which most lost >25% of their weight, and many experienced anemia, fatigue, apathy, extreme weakness, irritability, neurological deficits, and lower extremity edema. In 2003-2004, 18 of the original 36 participants were still alive and were interviewed.

 

CaptureMany came from the Historic Peace Churches (Mennonite, Brethren, and Quaker), and all expressed strong convictions about nonviolence and wanting to make a meaningful contribution during the war. Despite ethical issues about subjecting healthy humans to starvation, the men interviewed were unanimous in saying that they would do it all over again, even after knowing the suffering that they had experienced.

After the experiment ended, many of the participants went on to rebuilding war-torn Europe, working in the ministries, diplomatic careers, and other activities related to nonviolence.

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 […].

FORMULATION OF SORGHUM-PEANUT BLEND USING LINEAR PROGRAMMING FOR TREATMENT OF MODERATE ACUTE MALNUTRITION IN UGANDA

In Under-nutrition on November 16, 2013 at 7:14 pm

by Andrew K. Amegovu, Patrick Ogwok, Sophie Ochola, Peter Yiga, Juliet H. Musalima, Emma Mutenyo

from Journal of Food Chemisty and Nutrition – Vol 1, No 2 (2013)

(download)

Abstract

Infant and young child feeding practices in low-income countries are still inadequate leading to high rates of acute malnutrition. Formulas from local food materials are vital in formulations for management of child malnutrition in poor countries because they are affordable. Nutrient composition of sorghum-peanut blend (SPB) mixed with honey and ghee, and micronutrient-fortified corn-soy blend (CSB), a traditional food supplement, were analyzed. Proximate components and beta-carotene amounts were high in both products. Vitamin A level was higher in CSB than SPB. Proportions of essential fatty acids were low. Levels of iron, zinc, calcium, magnesium, phosphorus, potassium, manganese and sodium were adequate for recovery from moderate acute malnutrition (MAM). Energy content of CSB was 421kcal/100g while that of SPB was 430kcal/100g. Levels of condensed tannin, phytates, trypsin inhibitors and aflatoxins were below prescribed limits. In conclusion, levels of nutrients in SPB and CSB were adequate for treatment of MAM in children.

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