Combined protocol for severe and moderate acute malnutrition in emergencies

Stakeholder perspectives in four countries

Bibliographic Data

ID15537362
AuthorsSarah L Dalglish (0000-0002-7218-5193, Johns Hopkins University, corresponding author), Mamoudou Seni Badou (International Rescue Committee), Amin Sirat (International Rescue Committee), Omar Abdullahi (Somali International University), Mena Fundi Eso Adalbert (International Rescue Committee), Marie Biotteau (Mali-Folkecenter), Amelia Goldsmith (Johns Hopkins University), Naoko Kozuki (0000-0003-2850-3956, International Rescue Committee)
Year2019
Volume16
Issue2
Pagese12920-e12920
Publication date2019-11-26
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueMaternal and Child Nutrition (JOURNAL)
Journal identifiersISSN: 1740-8695 • E-ISSN: 1740-8709
PublisherWiley (PUBLISHER • GB)
DOI10.1111/mcn.12920
PMID31773867
OpenAlexW2991404930
LanguageEN
Citations received3
References cited24

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

Alternative medicine · Intensive care medicine · Malnutrition · Medical emergency · Pathology · Protocol (science · Public relations · Severe Acute Malnutrition · Stakeholder · Child Nutrition and Water Access · Food Security and Health in Diverse Populations · Medicine · Poverty, Education, and Child Welfare · Internal Medicine

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