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This CMAM training guide is designed for health care managers and providers who manage, supervise, and implement services for the management of acute malnutrition, including those involved in community outreach activities. The guide will also be useful for Ministry of Health officials at the national, regional, and district levels; health and nutrition program managers and technical staff of nongovernmental organizations; and United Nations technical staff involved in managing acute malnutrition in infants and children.
What Is Multisectoral Nutrition Programming and Why Is It Important?
To assess acute malnutrition with a population
based survey a large sample size is generally required. This is true even
when lot quality assurance sampling (LQAS), an otherwise time and cost
efficient method, is used. Cluster sampling, or sampling observations in
batches, offers an alternative to the large simple random sample size that
would typically be needed for LQAS analysis.
In emergency settings, data on mortality rates and the causes and circumstances of death are crucial to guide health interventions and monitor their effectiveness. Current methods to collect such data require substantial resources and feature important methodological limitations.
A significant gap remains between need
and capacity for management of severe acute malnutrition (SAM) in children.
This is despite clear advances in the development and implementation of
international and national protocols for the management of SAM, as well
as guidelines and training for inpatient care of severely acutely malnourished
children. The Training Guide for Community-Based Management of Acute Malnutrition
(CMAM) aims to address this gap by increasing knowledge of and building
practical skills to implement CMAM in both emergency and non-emergency
The objective of this paper is to provide
technical information and lessons learned to support the United States
Agency for International Development (USAID) and its partners to effectively
design and implement emergency food assistance programs in urban
and peri-urban settings.
In developing countries, where low-quality, monotonous grain- and tuber-based diets are the norm, the risk for micronutrient deficiencies is high. Women of reproductive age are among those most likely to suffer from micronutrient deficiencies, yet in developing countries there are very little data on women's micronutrient status and the quality of women's diets.
The Essential Nutrition Actions (ENA) package is an approach to expand the coverage of seven affordable and evidence-based actions to improve the nutritional status of women and children, especially those under two years of age.
In geographic areas and populations chronically vulnerable to food insecurity, early warning and response (EWR) systems can provide necessary information to help modify program interventions and increase resources in response to shocks. Trigger indicators (TIs) are one such EWR mechanism.
The lack of simple indicators of appropriate feeding practices has hampered progress in measuring and improving infant and young child feeding in developing countries. In response to these concerns, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) set in place a process in 2002 to review and develop indicators of appropriate feeding practices.
Many private voluntary organizations (PVOs)
are engaged in projects aimed at improving food security and household
nutrition worldwide. Increasingly they are being asked to monitor and evaluate
the impact of their interventions. USAID has developed a set of impact
indicators for household food consumption to help with the monitoring and
There are many of us living with conditions that demand that we improve our food intake. This includes those who have HIV/AIDS, TB, and other chronic debilitating conditions. These conditions increase our vulnerability to infections and to periodic decreased appetite. They also increase our nutrient needs and the need for special care in what food we eat, and how it is prepared and handled. This book provides guidelines on the kind of care we can give to people living with the above mentioned conditions, and the kind of diets that may improve our health and nutrition.
The Food and Nutrition Technical Assistance (FANTA) Project and the Regional Centre for Quality of Health Care (RCQHC) convened an HIV/AIDS and Food Aid: Assessment for Regional Programs and Resource Integration workshop in Entebbe, Uganda November 2-5, 2004. The workshop was funded by USAID's Regional Economic Development Services Office for East and Southern Africa's (REDSO).
This guide provides information for human
immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS)-affected
households and communities on how nutrition can help HIV-positive people
live healthier lives throughout the progression of HIV disease. Malnutrition
is a common complication of HIV infection and plays a significant and independent
role in its morbidity and mortality. Malnutrition was one of the earliest
complications of AIDS to be recognized and has been used to clinically
Community Therapeutic Care (CTC) is a new approach to managing acute malnutrition in emergencies and beyond. Conceived by Valid International, CTC seeks to address some of the challenges that traditional center-based approaches face. It aims to provide rapid, effective, low cost assistance that is least disruptive to affected communities and builds a foundation to link relief and development interventions for long-term solutions to food insecurity and threats to public health.
In Africa, where more than 25 million people
are living with HIV/AIDS, malnutrition and food insecurity are endemic.
Today, nearly 40% of African children < 5 years old are stunted due
to chronic nutritional deprivation. Underweight, an indicator of chronic
and acute malnutrition, was the leading cause of mortality worldwide, responsible
for 3.7 million deaths in 2000. Nearly half of these deaths (48.6%) occurred
in sub-Saharan Africa.
Over the past seven years, Title II Maternal and Child Health and Nutrition (MCHN) activities have evolved from predominantly facility-based food distribution programs targeted at undernourished children and their mothers, combined with some growth monitoring, to integrated community-based development programs with long-term health and sustainability objectives. The result of this shift has been a significant improvement in the nutritional status of children benefiting from these programs.
Although food security projects have always included capacity building activities, there is not enough monitoring, evaluation, and documentation of these activities to generate lessons learned and best practices. The USAID Office of Food for Peace's new strategic plan for 2004-08 will give a higher priority to capacity building activities within projects, providing an incentive for cooperating sponsors to more systematically conduct, monitor and evaluate capacity building activities within their projects.
The research for this report, conducted
between 2000 and 2003 by the Tufts University Friedman School of Nutrition
Science and Policy (FSNSP), tests the extent to which qualitative questionnaire
approaches devised for use in the United States during the 1990s (with
Tufts and Cornell involvement) can be adapted and enhanced for applications
in diverse developing country settings.