Adaptations to the Management of Acute Malnutrition in the Context of COVID-19

Acute malnutrition in children under five remains a critical challenge, exacerbated by the COVID-19 pandemic. Estimates indicate that up to 9.3 million more children will suffer from acute malnutrition by 2022. However, standard community-based management of acute malnutrition (CMAM) program models require proximity between health workers and patients, which may increase COVID-19 transmission risk. Furthermore, children must undergo frequent check-ups, a challenge under movement restrictions. Following guidance from nutrition coordinating bodies, organizations and governments adapted their standard CMAM protocols to continue nutrition service delivery while reducing COVID-19 transmission risks. These adaptations include changes to community-based screening methods; modified admission and discharge criteria; reduced frequency with which children return to health facilities for follow-up visits; modified dosage of therapeutic foods; and shifts in where and how treatment is provided. Many of these, often referred to as ‘simplified approaches’ to the current CMAM model, have been piloted or trialed previously. Still, questions remain regarding feasibility, effectiveness, and cost and operational implications. The mass rollout of these adaptations as the pandemic escalated in early 2020 presented a unique opportunity to examine them at an unprecedented scale. Therefore, Action Against Hunger USA, in collaboration with the United States Agency for International Development (USAID), the United Nations Children’s Fund (UNICEF), and the US Centers for Disease Control (CDC), carried out a mixed methods study between July 2020 and May 2021. This study sought to achieve two primary objectives: (1) to document operational adaptations to CMAM programs prior to and during COVID-19; and (2) to identify and document lessons learned and operational implications from adaptations. The findings presented in this report aim to both contribute to decision-making as the pandemic continues and to the simplified approaches evidence base by highlighting operational experiences and lessons learned. The report discusses takeaways consistent across adaptations and delineates lessons learned for five common adaptations: Family MUAC; modified admission and discharge criteria; reduced frequency of follow-up visits; modified dosage of therapeutic foods; and providing treatment when facilities were inaccessible.