Collaborating  to  improve  the  management  of
              acute malnutrition worldwide
              Management of Moderate Acute
              Malnutrition (MAM): Current Knowledge
              and Practice
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              Reginald A. Annan , Patrick Webb , Rebecca Brown
              1. Kwame Nkrumah University of Science and Technology, 
                KNUST, Kumasi, Ghana
              2. Friedman School of Nutrition Science and Policy, Tufts 
                University, Boston, USA
              3. CMAM Forum
              CMAM Forum Technical Brief: 
              September 2014
           Acknowledgements
           The authors would like to thank the following experts for their very helpful comments and contributions
           during the development of this brief: Susan Fuller, Erin Boyd, Hatty Barthorp and Maureen Gallagher
           and all members of the CMAM Forum Steering Committee. Special thanks also go to the following
           people who shared valuable information of their experiences of MAM management: Cecile Basquin,
           Shahid Fazal and David Doledec. Patrick Webb would also like to acknowledge the support provided by
           USAID’s Office of Food for Peace through its Food Aid Quality Review (FAQR) grant to the Friedman
           School at Tufts, as well as the entire FAQR team. 
           This technical brief was produced with funding from ECHO. The final content is the responsibility of
           the authors and does not formally represent the position of the CMAM Forum in relation to issues
           discussed.
           Abbreviations
            ACF    Action Contre la Faim / Action Against Hunger
            ART    Antiretroviral Therapy
            BCC    Behaviour Change Communication
            BSF    Blanket Supplementary Feeding
            BSFP   Blanket Supplementary Feeding Programmes
            CMAM Community based Management of Acute Malnutrition
            CSB    Corn Soy Blend
            CSM    Corn Soy Milk
            DSM    Dried Skimmed Milk
            EFA    Essential Fatty Acids
            ENN    Emergency Nutrition Network
            FANTA Food and Nutrition Technical Assistance
            FAO    Food and Agriculture Organisation of the United Nations
            FBF    Fortified Blended Foods
            FFP    USAID Office of Food For Peace
            GFD    General Food Distribution
            GAM    Global Acute Malnutrition
            GNC    Global Nutrition Cluster
            HEB    High Energy Biscuits
            HFA    Height-for-Age
            HIV    Human Immunodeficiency Virus
            IAEA   International Atomic Energy Agency
            IASC   Inter-Agency Standing Committee
            IMTF   International Malnutrition Task Force
            IPC    Integrated Food Security Phase Classification
            IYCF-E Infant and young child feeding - Emergencies
            LNS    Lipid-based Nutrient Supplement
            MAM Moderate Acute Malnutrition
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          MNP   Micronutrient Powder
          M&E   Monitoring and Evaluation
          MSF   Médecins Sans Frontières
          MUAC  Mid-Upper Arm Circumference
          NCHS  National Centre for Health Statistics
          NGO   Non-Governmental Organisation
          PDCAAS Protein Digestibility Corrected Amino Acid Score
          PLW   Pregnant and Lactating Women
          PUFA  Polyunsaturated Fatty Acids
          RCT   Randomised Controlled Trial
          cRCT  cluster Randomised Controlled Trial
          RDA   Recommended Daily Allowance
          RNI   Recommended Nutrient Intake
          RSB   Rice Soya Blend
          RUF   United Nations University
          RUSF  Ready-to-Use Supplementary Food
          RUTF  Ready-to-Use Supplementary Food
          SAM   Severe Acute Malnutrition
          SD    Standard Deviation
          SFP   Supplementary Feeding Programme
          TSFP  Targeted Supplementary Feeding Programme
          TFP   Therapeutic Feeding Programme
          UN    United Nations
          US    United States
          USDA  United States Department of Agriculture
          USAID United States Agency for International Development
          UNHCR United Nations High Commission for Refugees
          UNICEF United Nations Children’s Fund
          UNSCN United Nations Standing Committee on Nutrition
          WFA   Weight-for-Age
          WFH   Weight-for-Height
          WFP   World Food Programme
          WSB   Wheat Soy Blend
          WSM   Wheat Soy Milk
          WHO   World Health Organisation
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       Table of Contents
       1   Introduction..........................................................................................................................................5
        1.1   Brief Methodology  .....................................................................................................................5
        1.2   The Global Burden of MAM.......................................................................................................5
       2    The Management of MAM: Recent History ......................................................................................7
        2.1   Nutrition Counselling and Education..........................................................................................7
        2.2   Supplementary Feeding...............................................................................................................7
        2.3   Specialised Foods used for Supplementary Feeding...................................................................8
       3   An Overview of Current Guidance for MAM Management..............................................................10
        3.1   Principles of MAM Management..............................................................................................10
        3.2   MAM Management Decision Making Framework...................................................................11
        3.3   Recommended Nutrient Requirements for MAM.....................................................................12
        3.4   Targeted Supplementary Feeding Programmes (TSFPs)...........................................................15
          3.4.1   Target Population Groups..................................................................................................16
          3.4.2   Admission and Discharge Criteria.....................................................................................16
          3.4.3   Routine Medical Care........................................................................................................18
          3.4.4   Monitoring and Evaluation (M&E)...................................................................................18
          3.4.5   Referrals ............................................................................................................................18
          3.4.6   Coverage............................................................................................................................19
        3.5   Capacity Strengthening and Exit Strategy.................................................................................19
        3.6   Overview of Specialised Foods Currently used for MAM Management..................................19
          3.6.1   Fortified Blended Foods (FBF).........................................................................................19
          3.6.2   Lipid-based Nutrient Supplement (LNS) ..........................................................................20
       4   Effectiveness of specialised food products: recent reviews/meta-analyses.......................................21
        4.1   Effectiveness of targeted SFP....................................................................................................21
        4.2   Effectiveness of Specially-Formulated Foods in the treatment of MAM..................................21
       5   Challenges Faced in MAM Management..........................................................................................22
        5.1   Low profile and lack of consensus............................................................................................22
        5.2   Focus on products......................................................................................................................23
        5.3   Inconsistent definitions in MAM Management programmes....................................................23
        5.4   Evidence gaps  ..........................................................................................................................23
        5.5   Limited understanding of Nutrient Requirements for MAM  ...................................................24
        5.6   Gaps in consensus around MAM management protocols ........................................................24
        5.7   Lack of provision of basic medical treatment............................................................................25
        5.8   Constraints in monitoring and reporting of MAM management data.......................................25
       6   Way forward and conclusion..............................................................................................................25
       References...............................................................................................................................................27
       ANNEXES..............................................................................................................................................31
        ANNEX 1: MAM PROGRAMMATIC GUIDANCE.......................................................................31
        ANNEX 2: SUMMARY OF PRODUCTS FOR MAM MANAGEMENT......................................33
        ANNEX 3: RESOURCES RELATING TO THE MANAGEMENT OF MAM ..............................37
        TRAINING MANUALS AND GUIDELINES.................................................................................37
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