Combined protocol for severe and moderate acute malnutrition in emergencies: Stakeholders perspectives in four countries.

Omar Abdullahi,Amelia Goldsmith,Amin Sirat,Marie Biotteau,Sarah L. Dalglish,Naoko Kozuki,Mamoudou Seni Badou,Mena Fundi Eso Adalbert

doi:10.1111/mcn.12920

Abstract

Each year, acute malnutrition affects an estimated 52 million children under 5 years of age. Current global treatment protocols divide treatment of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) despite malnutrition being a spectrum disease. A proposed Combined Protocol provides for (a) treatment of MAM and SAM at the same location; (b) diagnosis using middle‐upper‐arm circumference (MUAC) and oedema only; (c) treatment using a single product, ready‐to‐use‐therapeutic food (RUTF), and (d) a simplified dosage schedule for RUTF. This study examines stakeholders' knowledge of and opinions on the Combined Protocol in Niger, Nigeria, Somalia, and South Sudan. Data collection included a document review followed by in‐depth interviews with 50 respondents from government, implementing partners, and multilateral agencies, plus 11 global and regional stakeholders. Data were analysed iteratively using thematic content analysis. We find that acute malnutrition protocols in these countries have not been substantially modified to include components of the Combined Protocol, although aspects were accepted for use in emergencies. Respondents generally agreed that MAM and SAM treatment should be provided in the same location, however they said MUAC and oedema‐only diagnosis, although more field‐ready than other diagnostic measures, did not necessarily catch all malnourished children and may not be appropriate for “tall and slim” morphologies. Similarly, using only RUTF presented inherent logistical advantages, but respondents worried about pipeline issues. Respondents did not express strong opinions about simplified dosage schedules. Stakeholders interviewed indicated more evidence is needed on the operational implications and effectiveness of the Combined Protocol in different contexts.

Highlights

Each year, an estimated 52 million children under 5 years of age suffer from acute malnutrition (WHO, & World Bank Group, 2019)
In the absence of codified global guidelines, moderate acute malnutrition (MAM) is often treated with ready‐to‐use supplementary food (RUSF) or corn soy blend++ in Supplementary Feeding Programs (SFPs), supplied and led by the World Food Programme (WFP)
The International Rescue Committee (IRC) alongside other global actors has been researching the use of a Combined Protocol to manage both conditions, with diagnostic criteria adapted for emergency settings as well as a simplified dosage schedule

Summary

Introduction

An estimated 52 million children under 5 years of age suffer from acute malnutrition (WHO, & World Bank Group, 2019). The International Rescue Committee (IRC) alongside other global actors has been researching the use of a Combined Protocol to manage both conditions, with diagnostic criteria adapted for emergency settings (only middle‐upper‐arm circumference, MUAC, and oedema instead of both MUAC and weight‐for‐height z‐score, WHZ, together with oedema) as well as a simplified dosage schedule. These approaches are meant to provide harmonized technical guidance, cost‐efficient supply management, and optimal care for the greatest number of children and families under challenging circumstances. This protocol was tested by the IRC in a randomized controlled trial known as the Combined Protocol for Acute Malnutrition (ComPAS) trial, with results pending (Figure 1; Bailey et al, 2016; Bailey et al, 2018)

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Conclusion