What is CMAM?
CommunityBased Management of Acute Malnutrition (CMAM) is an evidencebased approach that shifts the treatment of severe and moderate acute malnutrition (SAM & MAM) from inpatient hospitals to the community level. It combines early detection, outpatient therapeutic feeding, and a strong referral system for cases that need intensive care. The model was first introduced in the early 2000s and is now endorsed by the World Health Organization (WHO), UNICEF, and many national ministries of health.
Core Principles
- Early detection: Routine screening of children under five and pregnant/lactating women at community sites.
- Outpatient treatment: Use of readytouse therapeutic foods (RUTF) for SAM without medical complications.
- Integration: Links with routine health services such as immunisation, growth monitoring, and deworming.
- Referral: Clear criteria for referring complicated cases to inpatient care.
- Community involvement: Engagement of local volunteers, mothers groups, and religious leaders to encourage uptake.
How CMAM Works
1. Community Screening
Health workers or trained volunteers use simple tools (e.g., MUAC tape, weightforheight charts) to screen children in homes, schools, and health posts. Children are classified as:
- Severe Acute Malnutrition (SAM) MUAC<11.5cm or edema.
- Moderate Acute Malnutrition (MAM) MUAC11.512.5cm without edema.
2. Outpatient Therapeutic Care (OTC)
Children with uncomplicated SAM receive:
- Readytouse therapeutic food (RUTF) usually a peanutbased paste.
- Antibiotics (usually a 7day course of amoxicillin).
- Vitamin A supplementation and deworming where indicated.
Followup visits occur every 12weeks to monitor weight gain, check for complications, and replenish RUTF.
3. Supplementary Feeding Program (SFP)
MAM children receive readytouse supplementary food (RUSF) or locally produced fortified blended flours, along with nutrition counselling.
4. Referral and Inpatient Care
If a child shows any medical complications (e.g., severe infection, persistent vomiting, severe edema), they are referred to the nearest health facility for inpatient management.
5. Discharge and Aftercare
Discharge criteria typically include:
- MUAC12.5cm for two consecutive visits.
- Weight gain of at least 15% of admission weight.
After discharge, families receive counselling on continued feeding practices and are linked to growth monitoring services.
Benefits of the CMAM Approach
Reduced mortality: Studies show a 3050% drop in casefatality rates when CMAM replaces inpatientonly care.
Higher coverage: Community outreach reaches children who would otherwise never reach a hospital.
Costeffectiveness: Outpatient care costs 3040% less per cured child than inpatient treatment.
Empowerment: Involving caregivers builds local capacity and improves longterm nutrition practices.
Challenges & Solutions
Supply Chain Management
Inconsistent RUTF deliveries can interrupt treatment. Solutions include:
- Establishing buffer stocks at district warehouses.
- Partnering with local manufacturers where quality standards can be met.
Human Resources
High turnover of community health workers reduces continuity.
- Provide regular refresher trainings.
- Introduce modest incentives (e.g., stipends, recognition awards).
Cultural Acceptance
Some families reject RUTF due to misconceptions.
- Engage trusted community leaders to demonstrate use.
- Integrate nutrition education into existing womens groups.
Data Quality
Incomplete reporting hampers monitoring.
- Adopt simple mobilebased reporting tools.
- Conduct quarterly supervision visits focused on data verification.
Further Resources
When families are supported within their own communities, children recover faster, and the health system can focus its limited resources on the most critical cases. Nutrition Programme Manager, Global Relief Agency
