Community Management of Acute Malnutrition(CMAM)
CMAM - The New Approach
Much of the treatment of Severe Acute Malnutrition (SAM) in India has been restricted to medical facilities. Nutritional Rehabilitation Centres, spearheaded by Departments of Health across the country, take in patients for almost month-long treatments. However, the NRCs have limited number of hospital beds, and mothers (in staying with their children) forgo essential workdays. Effectively, this in-patient treatment of SAM has extremely limited coverage for a country like India.
Community Management of Acute Malnutrition is a treatment philosophy that seeks to shift the treatment of a SAM-afflicted child within the community itself, in the process saving up precious hospital beds, and logistical and time costs for the impoverished. This ensures that the treatment of SAM has a far wider coverage than any which could achieve through in-patient treatment of SAM.
There are six key aspects to CMAM:
1. Enumeration of SAM children:
The National Family Health Survey and Ministry of Women and Child Development have made great progress in this regard. In 2015-16 survey the NFHS Survey tabulated that around 7.5% of all children are severely malnourished (SAM) .
2. Specialised foods should be Ready-to-Use Therapeutic Food:
RUTF, Ready to Use Therapeutic Food, is a tried and tested alternative and has been used extensively in the treatment of SAM. With RUTF, the total treatment of SAM child may take unto 6 to 8 weeks only. RUTF is meant as a curative medicinal product only. It is not intended to replace local dietary practices and breast feeding.
3. Adequate management and implementation:
Policy framework should ultimately be institutionalised with adequate oversight and management from responsible authorities.
4. General education of mothers about nutrition & feeding practices:
The ideal policy framework should also ensure that mothers are educated about the importance of nutrition practices like breast feeding etc.
5. Institution of a system for intervention with specialised food:
Here the policy ought to optimise a system of health workers that can intervene regularly in the community. This means that the health workers should be able to (a) detect SAM children; (b) administer feedings with the consent of mothers; (c) monitor future feedings; (d) educate mother and parents about the best nutrition practices.
6. Community mobilization:
Building relationships and fostering active participation of the community by engaging them directly in the process of nutritional intervention bolsters support for mothers with SAM children, and in turn allows for smoother treatment of SAM kids.