Solutions to Malnutrition: ACF’s integrated approach
Action Against Hunger tackles acute malnutrition using an integrated nutrition strategy. This approach combines the assessment of nutritional status of children, treatment of acute malnutrition, and prevention of all forms of malnutrition.
Community-based management of acute malnutrition
Action Against Hunger’s assessment, treatment and prevention activities are designed and carried out together with communities and health services. Until recently, children suffering from severe acute malnutrition (SAM) were treated in intensive-care inpatient facilities known as ‘Therapeutic Feeding Centres.’ These hospital-like centres required children and their parents or caregivers to remain in residence during their month-long treatment.
The recent development of innovative food products for treating severe acute malnutrition, known as Ready-to-Use Therapeutic Foods (RUTF), now permits treatment to take place in the community at any time and place, resulting in a shift towards new outpatient treatment programmes. Such programmes, known as Community-Based Management of Acute Malnutrition, offer severely malnourished children the opportunity to be treated at home, rather than in a centre, with family and community support for recovery. Health professionals assist communities to diagnose nutritional problems, and oversee community-level activities.
Ready-to-use therapeutic foods
Ready-to-Use Therapeutic Foods have been developed in the form of peanut-butter based pastes and biscuits that are nutrient-rich and packed with high concentrations of protein and energy. RUTFs reduce exposure to water-borne bacteria as they contain no water. They require no refrigeration and are ready to serve, ensuring that essential nutrients are not lost by the time the products are consumed. With no water, heating or preparation required, RUTFs avoid all of the major inconveniences of therapeutic milk-based products, which are the standard treatment in inpatient care of severe acute malnutrition.
CMAM and RUTF have resulted in revolutionary changes in the fight to overcome acute malnutrition by enabling:
A massive scaling-up of treatment programmes to cover many more malnourished children
Increased coverage, with broader access to treatment
A reduction in social costs associated with SAM treatment, as parents and caregivers are able to treat severely malnourished children without medical complications at home, without leaving the rest of the family or foregoing income-generating activities
CMAM includes three main elements:
- Community Outreach
- Outpatient Care: home treatment
- Inpatient Care: hospital or health facility treatment
To reach as many acutely malnourished children as possible and achieve maximum programme coverage, CMAM depends on community involvement in all aspects of the programme. Known as Community Outreach, this aspect of CMAM includes community assessment of nutritional status, community mobilisation, active case-finding of acutely malnourished children, and referral and case follow-up. Community volunteers work directly with malnourished children and their families. Alongside local health professionals and volunteers, Action Against Hunger’s teams assess the nutritional status of childen and identify new cases of malnutrition as early as possible, so that timely interventions can prevent further deterioration. By working in partnership with local health services, Action Against Hunger aims to integrate the assessment, treatment, and prevention of acute malnutrition into national, regional and local healthcare systems.
Children diagnosed with moderate acute malnutrition are provided with care and support, which may include food and micronutrient supplements, medical treatment, if needed, and nutrition advice/education for parents and caregivers. Nutrition education can include information on optimal infant and child feeding and care practices, advice on hygiene and sanitation, and the prevention of illness, and psycho-social support. The weight and height of children with moderate acute malnutrition are monitored regularly in order to prevent deterioration into severe acute malnutrition.
Outpatient care: home treatment
Children treated through community-based Outpatient care represent 80 percent of all cases of severe acute malnutrition. Those who are clinically stable, have no medical complications, and still have an appetite, are directly admitted to a programme of home treatment that is supported by weekly visits to “stabilisation centres “ (either hospitals or health centres) for medical supervision. Weekly visits allow health professionals to evaluate the children’s progress and provide them with a weekly supply of RUTF for home treatment. The visits also allow acutely malnourished children to receive preventative measures and treatment for infections, illnesses, and micronutrient deficiencies (such as antibiotics, vitamin A, de-worming tablets, immunisations, etc). Follow–up visits can continue for up to two months, depending on the child’s progress and recovery.
Inpatient care: hospital or health facility treatment
A child who does not have an appetite, does not gain weight, and/or exhibits serious medical complications is admitted to a specialised hospital, clinic, or other inpatient health facility where s/he is treated using therapeutic milk products. Such children represent about 20 percent of cases of severe acute malnutrition. When a child with severe acute malnutrition and medical complications has regained his/her appetite and medical problems have been successfully treated, s/he is transferred to outpatient care. A child may remain in inpatient care for four to seven days, depending on his/her recovery.