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Kennedy E.,Tufts University | Branca F.,World Health Organization | Webb P.,Tufts University | Bhutta Z.,Sick Kids Center for Global Child Health | Brown R.,CMAM Forum
Food and Nutrition Bulletin | Year: 2015

Background. Moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) continue to exist at unacceptably high levels. There is a renewed momentum to dramatically improve nutritional status and decrease rates of malnutrition of all kinds. Although much focus is on the first 1,000 days, the period from conception to age 2 years, in relation to growth retardation (or stunting), it is just as important to pay adequate attention to wasting as a major contributor to both morbidity and mortality. Objective. This paper reviews what is known about effective approaches for treatment and prevention of MAM and SAM, highlights nutrition blind spots in our strategies, and identifies programmatic and research gaps that, if addressed, will enhance our understanding of the menu of cost-effective approaches to alleviate acute forms of malnutrition. Methods. The paper synthesizes presentations from the opening session of a May 2014 International Atomic Energy Agency symposium on Moderate Acute Malnutrition held in Vienna, Austria. Results. Although understanding of efficacious approaches to the treatment and prevention of MAM and SAM has recently improved, the evidence base for informed policies and programs remains limited. Conclusions. If priority evidence gaps can be urgently addressed, our understanding of the menu of cost-effective interventions to alleviate acute forms of malnutrition will be considerably enhanced and the potential for impact at global scale significantly increased. Copyright © 2015 International Atomic Energy Agency.

De Pee S.,Nutrition Advisory Office OSN | De Pee S.,Tufts University | Grais R.,Epicentre | Brown R.,CMAM Forum | And 4 more authors.
Food and Nutrition Bulletin | Year: 2015

Acute malnutrition is associated with increased morbidity and mortality risk. When episodes are prolonged or frequent, acute malnutrition is also associated with poor growth and development, which contributes to stunting. Nutrition-specific and nutrition-sensitive strategies to prevent undernutrition during the first 1,000 days from conception to 24 months of age can reduce the risks of wasting, stunting, and micronutrient deficiencies. Under circumstances that exacerbate the underlying causes of undernutrition and increase the incidence of wasting, such as food insecurity related to lean seasons or emergencies, or increased incidence of illness, such as diarrhea or measles, additional efforts are required to prevent and treat wasting. Special nutritious foods directly meet the increased nutrient requirements of children at risk for wasting; assistance to vulnerable households, in the form of cash or food, enables households to better meet the food, health, and other needs of household members and may increase resilience; water, sanitation, and hygiene (WASH) and health interventions help prevent and address illness and hence reduce wasting risk. The contributions of specific interventions to reducing the incidence of wasting are difficult to assess under emergency conditions, due to ethical constraints and to the fact that multiple strategies are implemented at the same time. However, pragmatic studies under reallife circumstances, using different designs, e.g., including a group receiving "best possible" treatment, can provide evidence about what works, to what extent, at what cost, and under which circumstances. Programs should address the most important causes in given contexts, be feasible to implement at scale, and assess implementation, coverage, and outcomes. Copyright © 2015 International Atomic Energy Agency.

Dent N.,CMAM Forum | Deconinck H.,CMAM Forum | Golden K.,Concern Worldwide | Brown R.,CMAM Forum | Walsh A.,Valid International
Food and Nutrition Bulletin | Year: 2014

Background. Severe acute malnutrition (SAM) affects 19 million children worldwide annually. The community-based management of acute malnutrition (CMAM) approach was first piloted in 2000. Endorsed by the United Nations in 2007, the approach has been introduced in over 60 countries. Current coverage and quality of services need further strengthening and key stakeholders have expressed the need for improved information-sharing. Objective. To report on an information-sharing initiative that was established to support scale-up of quality services for CMAM by collecting existing technical guidance, evidence, and learning. Methods. Routine website monitoring, country case studies, and surveys were used to assess the profiles of CMAM Forum users and the reach and use of information for improved health outcomes. Results. The number of information products and services and their use have steadily increased. Country case studies have identified ways to adapt information better to the needs of those involved in managing acute malnutrition, particularly at the country level. An urgent need has been identified for more resources in additional languages, especially French and Arabic, and expanded production and use of audiovisual material and social media. Conclusions. Improved information-sharing can have an impact on health outcomes, but further innovation and support are needed to improve access to, and use of, the information. © 2014, The Nevin Scrimshaw International Nutrition Foundation.

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