evidence-based blog of Filippo Dibari

Posts Tagged ‘cmam’

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



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.


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]


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 […].

Locally-Prepared Ready-to-Use Therapeutic Food for Children with Severe Acute Malnutrition: A Controlled Trial

In Under-nutrition on June 4, 2013 at 8:14 pm

by Govind Singh Thakur, HP Singhand Chhavi Patel

Indian Pediatrics – Vol. 50, March 16 2013

(download the paper)


Objective: To compare the efficacy of locally-prepared ready-to-use therapeutic food (LRUTF) and locally-prepared F100 diet in promoting weight-gain in children with severe acute malnutrition during rehabilitation phase in hospital.

Study design: Non-randomized Controlled trial.
Setting: Pediatric ward of tertiary care public hospital in Central India.
Study period: 1 October, 2009 to 30th May, 2010.
Subjects: Children aged 6 to 60 months, diagnosed as severe acute malnutrition and hospitalized during study period.

Intervention: Random group allocation followed for selection of intervention and control cohorts. The control cohort enrolled during October 1, 2009 to January 31, 2010 received F100 while the intervention cohort enrolled during 1 February to 15 May 2010 received LRUTF. Subjects receiving either of the two therapeutic foods were temporally separated to minimize the spillover effect. The study subjects and the technician delegated for measuring weight was blinded for type of intervention.

Primary outcome variable: Rate of weight-gain/kg/day.

Results: There were 49 subjects in each group. Both groups were comparable. Rate of weight-gain was found to be (9.59±3.39 g/kg/d) in LRUTF group and (5.41 ± 1.05 g/kg/d) in locally prepared F100 group. Significant difference in rate of weight gain was observed in LRUTF group (P<0.0001; 95% CI 3.17-5.19). No serious adverse effect was observed with use of LRUTF.
Conclusion: LRUTF promotes more rapid weight-gain when compared with F100 in patients with severe acute malnutrition during rehabilitation phase.

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

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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Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

In Under-nutrition on October 25, 2012 at 8:50 am

Tekeste AWondafrash MAzene GDeribe K.

Cost Eff Resour Alloc. 2012 Mar 19;10:4




This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition (SAM) in Sidama Zone, Ethiopia compared to facility based therapeutic feeding center (TFC).


A cost effectiveness analysis comparing costs and outcomes of two treatment programmes was conducted. The societal perspective, which considers costs to all sectors of the society, was employed. Outcomes and health service costs of CTC and TFC were obtained from Save the Children USA (SC/USA) CTC and TFC programme, government health services and UNICEF(in kind supplies) cost estimates of unit costs. Parental costs were estimated through interviewing 306 caretakers. Cost categories were compared and a single cost effectiveness ratio of costs to treat a child with SAM in each program (regardless of outcome) was computed and compared.


A total of 328 patient cards/records of children treated in the programs were reviewed; out of which 306 (157 CTC and 149 TFC) were traced back to their households to interview their caretakers. The cure rate in TFC was 95.36% compared to 94.30% in CTC. The death rate in TFC was 0% and in CTC 1.2%. The mean cost per child treated was $284.56 in TFC and $134.88 in CTC. The institutional cost per child treated was $262.62 in TFC and $128.58 in CTC. Out of these institutional costs in TFC 46.6% was personnel cost. In contrast, majority (43.2%) of the institutional costs in CTC went to ready to use therapeutic food (RUTF). The opportunity cost per caretaker in the TFC was $21.01 whereas it was $5.87 in CTC. The result of this study shows that community based CTC was two times more cost effective than TFC.


CTC was found to be relatively more cost effective than TFC in this setting. This indicates that CTC is a viable approach on just economic grounds in addition to other benefits such improved access, sustainability and appropriateness documented elsewhere. If costs of RUTF can be reduced such as through local production the CTC costs per child can be further reduced as RUTF constitutes the highest cost in these study settings.


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