Management of Moderate Acute Malnutrition

This module is about the management of moderate acute malnutrition (MAM) with an emphasis on emergency Supplementary Feeding Programmes (SFPs). These aim to prevent individuals with MAM from developing severe acute malnutrition (SAM), to treat those with MAM and to prevent the development of moderate malnutrition in individuals. Protocols have changed little over the years, however currently management of MAM is attracting considerable review and operational research with on-going initiatives aimed at improving the dietary management of MAM through adjusting the nutrient composition of food supplements used and emphasising more preventative measures. This module summarises key elements of current guidelines and guides readers to best practice based on the diversity of approaches seen in the field.
Key messages
1. In emergencies, moderate malnutrition can be addressed through blanket or targeted supplementary feeding programmes.
2. Blanket supplementary feeding is generally used as a preventive measure among a specific target group for a specific period of time in order to prevent MAM in the population.
3. Targeted SFPs are generally used for treatment of MAM within individuals based on anthropometric admission criteria.
4. Programmes involving take home supplementary rations (dry feeding) are preferable in most situations to on-site (wet feeding) SFPs.
5. Although children under five and pregnant and breastfeeding women are the usual priority target groups, targets groups should be based on nutritional vulnerability.
6. SFP rations are meant to be additional to regular intake. Where household food insecurity and/or general food distributions (GFDs) are inadequate, programme objectives may need to be modified and implementing agencies must advocate for improved GFDs.
7. Rations should always be energy dense, micronutrient rich and culturally appropriate.
8. Targeted SFPs should always include a set of routine medical treatments. Blanket SFPs are an opportunity for nutrition screening and referral, and where needed additional medical care/supplementation, but this is not standard practice.
9. A number of programme indicators should always be monitored and analysed in relation to Sphere standards. Meeting these standards may be challenging in some circumstances due to constraints outside the control of implementing agencies.
10. SFP programming should be done in as integrated manner as possible, with linkages to infant and young child feeding support, livelihoods and health programming where feasible and appropriate.
11. Methods to manage MAM continue to evolve. Key areas include the types of food commodity used, and methods to improve overall performance and impact at individual and population level.