Category: Management of severe acute malnutrition (SAM)

A pragmatic approach to treating severe malnutrition in emergencies: is F75 always beneficial?

This article describes MSF’s experience of implementing a therapeutic feeding programme for adults in Wau, southern Sudan in 1998.

Issue 15, April 2002 (page 11)

Acceptability trial of a novel RUTF based on soy, lentils and rice

This article shares the preliminary results of an exploratory trial of a ready-to-use therapeutic food based on soy, lentils and rice, produced in Sri Lanka.

Issue 39, September 2010 (page 13)

Adapted MSF nutrition guidelines on F75

Prompted by recent operational findings, MSF has decided to modify its Nutrition Guidelines to promote the use of F75 in Phase I treatment of severe malnutrition.

Issue 19, July 2003 (page 19)

Adopting CTC from Scratch in Ethiopia (Special Supplement 2)

Save the Children USA (SC-US) implemented an emergency health and nutrition programme in Sidama zone of SNNP region of Ethiopia, in response to the 2003 food crisis.

Supplement 2, November 2004 (page 30)

Alternative RUTF formulations (Special Supplement 2)

Developing CTC programmes that use Ready to Use Therapeutic Food (RUTF) made locally, from locally available produce, and used to treat malnutrition and HIV amongst the local population, is an important vision for the future of CTC.

Supplement 2, November 2004 (page 35)

Ambulatory treatment of severe malnutrition in Afghanistan

Faryab province is in a remote and poor area in the north of Afghanistan. There is little infrastructure, a high risk of disease outbreaks such as cholera and measles, and malnutrition is endemic.

Issue 19, July 2003 (page 14)

Antibiotics as part of the management of severe acute malnutrition

Summary of published research.

Issue 45, May 2013 (page 13)

Antioxidant Role in Preventing Kwashiorkor

Summary of published research.

Issue 26, November 2005 (page 14)

Assessing the economic value of fortified foods

Summary of published paper.

Issue 14, November 2001 (page 6)

Capacity development of the national health system for CMAM scale up in Sierra Leone

Socio-economic status The Republic of Sierra Leone is situated on the West Coast of Africa, bordering the North Atlantic Ocean, between Guinea and Liberia. Its land area covers approximately 71,740 sq. km. The estimated projected population for 2011 is 5,876,936 inhabitants, of which approximately 37% reside in urban areas.

Issue 43, July 2012 (page 40)

Carbon Dioxide Production in Acutely Ill Malnourished Children

Summary of published paper.

Issue 22, July 2004 (page 9)

Caring for Severely Malnourished Children: Book Review

The last issue of Field Exchange reported on the publication of a new book ‘Caring for Severely Malnourished Children’ by Ann Ashworth and Ann Burgess.

Issue 20, November 2003 (page 16)

Caring for Unaccompanied Children under Difficult Circumstances

Generally, emergency interventions are conceptualised as having an impact on nutritional status through a combination of strengthening food security, health service provision and providing or supporting caring practices.

Issue 4, June 1998 (page 4)

Case Studies (Special Supplement 2)

Case Studies.

Supplement 2, November 2004 (page 14)

Cellophane bags and clean water: A novel way of producing safe therapeutic milk and ORS?

Most people will have come across cellophane, its the packaging for many sweets, pies and other goodies.

Issue 1, May 1997 (page 10)

Challenges and Opportunities in Integrating CTC and Food Security Programmes in Malawi (Special Supplement 2)

As with the majority of famines and food crises, the 2002-3 Malawi crisis was caused by the interaction of many pre-existing factors of vulnerability that combined to over-stretch fragile coping capacities.

Supplement 2, November 2004 (page 46)

cIYCF in Zimbabwe

Zimbabwe has a high prevalence of stunting (32%) and low prevalence of wasting/acute malnutrition (3%) (DHS 2011).

Issue 43, July 2012 (page 97)

Clinical Trial of BP100 vs F100 Milk for Rehabilitation of Severe Malnutrition

This article describes the main findings of a clinical trial by ACF in Sierra Leone, which compares the use of solid RUTF (BP100) with the standard F100 treatment, during the rehabilitation phase of a TFC.

Issue 24, March 2005 (page 22)

CMAM in India: What happened next?

State-level actors in India have been quick to use the momentum established at the Community based Management of Acute Malnutrition (CMAM) Conference in Addis Ababa to take forward the severe acute malnutrition (SAM) agenda.

Issue 43, July 2012 (page 88)

CMAM rollout in Ethiopia: the ‘way in’ to scale up nutrition

Globally, more than 3.5 million children under the age of five year die each year due to the underlying causes of malnutrition. It is also estimated that 13 million infants are born each year with low birth weight (LBW), 55 million children are wasted (of which 19 million are severely wasted) and 178 million are Stunted.

Issue 43, July 2012 (page 16)

Collecting Evidence for Community Based Treatment of Severe Malnutrition

The Child and Adolescent Health Department and the Department of Nutrition for Health and Development of WHO, in collaboration with the Standing Committee for Nutrition of the United Nations, have begun the process to formulate recommendations on the community based management of severe malnutrition.

Issue 26, November 2005 (page 21)

Commentary: Regional Training on Integrated Management of Severe Malnutrition

WHO and UNICEF came together in Tanzania in September 2006 to hold a joint training on the Integrated Management of Severe Malnutrition.

Issue 29, December 2006 (page 34)

Community based approaches to managing severe malnutrition: case study from Ethiopia

A recent published paper describes Save the Children US’s (SC US) experience of setting up a community therapeutic care (CTC) programme in the Southern Nations, Nationalities and Peoples Region (SNNPR), Ethiopia, following a drought in the lowlands of the region in 2003.

Issue 30, April 2007 (page 7)

Community care: addressing the management of severe malnutrition

Summary of published paper.

Issue 14, November 2001 (page 4)

Community case management of severe acute malnutrition in southern Bangladesh

Summary of study.

Issue 42, January 2012 (page 12)

Community management of acute malnutrition in Mozambique

Mozambique has just over 20 million inhabitants, of whom approximately 17% are less than five years of age. More than half of the population (55%) lives in poverty.

Issue 43, July 2012 (page 46)

Community Participation and Mobilisation in CTC (Special Supplement 2)

Over the last few years of CTC development, the process of community participation and mobilisation has become central to the search for more efficient and more sustainable strategies to manage malnutrition.

Supplement 2, November 2004 (page 43)

Community-based Approaches to Managing Severe Malnutrition

A three day meeting was held in Dublin hosted by Concern and Valid International between 8-10th of October, 2003 on community-based treatment1 of the severely malnourished.

Issue 21, March 2004 (page 16)

Community-based Therapeutic Care (CTC)

Summary of published research.

Issue 19, July 2003 (page 6)

Community-based Therapeutic Care (CTC): A Field Manual

Community Therapeutic Care (CTC) is an approach to managing acute malnutrition that has regularly featured in Field Exchange and was the subject of an ENN special supplement.

Issue 29, December 2006 (page 33)

Comparison of the Efficacy of a Solid Ready-to-Use Food and a Liquid, Milk- Based Diet in Treating Severe Malnutrition

Summary of published research.

Issue 20, November 2003 (page 5)

Conference on Government experiences of CMAM scale-up

In November 2011, ENN, in collaboration with the Government of Ethiopia (GoE) hosted a 4-day conference in Addis Ababa at which Government representatives from 22 countries in Africa and Asia, as well as members of international non-governmental organisations (NGOs), UN agencies, the private sector, academic institutions and donor agencies came together to share experiences and to identify lessons for further future CMAM scale up.

Issue 43, July 2012 (page 64)

Cost effectiveness of CMAM in Malawi

Summary of published research.

Issue 41, August 2011 (page 24)

Cost effectiveness of community-based and inpatient therapeutic feeding programmes to treat SAM in Ethiopia

Aretrospective study was recently conducted in SNNPR, Ethiopia to determine the average cost of treatment of a severely malnourished child in a therapeutic feeding centre (TFC) and in a community based therapeutic care (CTC) programme, to determine the effectiveness of TFC and CTC programmes as measured by the clinical outcomes, and to compare the cost effectiveness of the two approaches.

Issue 41, August 2011 (page 22)

Cost-effective Treatment for Severely Malnourished Children: What is the Best Approach?

Summary of Published Paper.

Issue 2, August 1997 (page 12)

Creating an enabling policy environment for effective CMAM implementation in Malawi

The Community based Management of Acute Malnutrition (CMAM) approach aims to increase the coverage and accessibility of treatment for acute Malnutrition.

Issue 43, July 2012 (page 74)

CTC Approach (Special Supplement 2)

Community Therapeutic Care (CTC) is a community-based model for delivering care to malnourished people. CTC seeks to provide fast, effective and cost efficient assistance in a manner that empowers the affected communities and creates a platform for longer-term solutions to the problems of food security and public health.

Supplement 2, November 2004 (page 6)

CTC from Scratch - Tear Fund in South Sudan (Special Supplement 2)

Tearfund has been working in Northern Bahr el Ghazal, southern Sudan, in the nutrition sector since 1998.

Supplement 2, November 2004 (page 28)

CTC in Ethiopia- Working from CTC Principles (Special Supplement 2)

In December 2002, nutrition surveys carried out by Concern Worldwide, in collaboration with Amhara Region Disasters, Preparedness and Prevention Bureau (DPPB), reported acute malnutrition levels of 17.2% global malnutrition and 3.1% severe malnutrition (based on weight for height in z scores) in Kalu and Dessie Zuria districts, South Wollo. .

Supplement 2, November 2004 (page 14)

CTC in North Darfur, North Sudan: challenges of implementation (Special Supplement 2)

North Darfur state lies 1000 km to the west of Khartoum. It is an area the size of France but is inhabited by only 1.4 million people.

Supplement 2, November 2004 (page 22)

CTC in South Sudan - A Comparison of Agency Approaches and the Dilemmas Involved (Special Supplement 2)

In 2003 both Concern Worldwide and Tearfund asked Valid International to support them in the setting-up of CTC programmes to address high rates of acute malnutrition in South Sudan.

Supplement 2, November 2004 (page 25)

Cultural integration in CTC: Practical suggestions for project implementers (Special Supplement 2)

The SPHERE guidelines touch only superficially on culture and the cultural acceptability of humanitarian assistance. However, in recent decades, the wider field of international health has produced a variety of initiatives intended to account for culture in the design and delivery of programmes.

Supplement 2, November 2004 (page 41)

Debate on the Management of Severe Malnutrition

In May 2003, a new publication, Caring for severely malnourished children, Ashworth and Burgess, 2003 1 , met with some technical criticism from Professor Mike Golden in the form of a book critique submitted to ENN, and circulated to the publishers and supporting agencies (see Field Exchange 19, pp 19).

Issue 20, November 2003 (page 16)

Debate on the Management of Severe Malnutrition : A Response

Many individuals and organisations, including NGOs, have contributed to the improved treatment of children with severe malnutrition, but case-management remains very poor in most hospitals in developing countries and many children die as a result.

Issue 20, November 2003 (page 17)

Decentralisation and scale up of outpatient management of SAM in Ethiopia (2008-2010)

This article describes experiences and observations around the successful decentralisation and scale up of the outpatient management of severe acute malnutrition in Ethiopia in the period 2008 to 2010. It includes achievements, the challenges around monitoring and reporting and ongoing steps needed to strengthen and assure service quality.

Issue 40, February 2011 (page 39)

Decentralisation of out-patient management of severe malnutrition in Ethiopia

This article describes the large-scale rollout of outpatient therapeutic care in Ethiopia in response to the 2008 escalation in severe acute malnutrition.

Issue 36, July 2009 (page 12)

Dietary Treatment of Severe Malnutrition in Adults

A recently published paper reports the results of a study conducted by Concern Worldwide on severely malnourished adults in Baidoa, Somalia, a town at the epicentre of the 1992 famine.

Issue 6, February 1999 (page 11)

Diluted F100 v infant formula in treatment of severely malnourished infants < 6 months

This article reports the main findings of a study which aimed to address one of the ongoing debates concerning the treatment of infants <6m - which supplemental milk is the most appropriate to use in their treatment?.

Issue 37, November 2009 (page 18)

Do children with uncomplicated severe acute malnutrition need antibiotics?

Summary of review.

Issue 45, May 2013 (page 14)

Early stages of a ‘Food by Prescription’ programme for HIV infected adults

As global interest in Ready-to-Use Therapeutic Foods (RUTFs) has risen, their use has begun expanding beyond the realm of treating children with severe acute malnutrition (SAM). Of recent interest within the humanitarian community is the use of such products in treating malnourished adults living with HIV/AIDS.

Issue 40, February 2011 (page 83)

Éditorial (français)

Cette édition spéciale de Field Exchange consacrée aux « Leçons pour le déploiement de la prise en charge communautaire de la malnutrition aiguë (PCMA) » vise principalement à fournir des éclairages sur le déploiement de la PCMA d’un point de vue gouvernemental. Une grande partie de ce numéro porte en conséquence sur le déroulement de la conférence internationale sur les expériences gouvernementales en matière de déploiement de la PCMA qui s’est tenue à Addis-Abeba du 14 au 17 novembre 2011.

Issue 43, July 2012 (page 2)

Effectiveness of Integrated Outpatient Care of Severe Acute Malnutrition in Ethiopia

Community-based management of acute malnutrition (CMAM) has been implemented in Ethiopia by various non-governmental organisations (NGOs) in response to emergencies.

Issue 34, October 2008 (page 8)

Effectiveness of public health systems to support national rollout strategies in Ghana

Like most developing countries, Ghana is faced with high rates of malnutrition. According to the Ghana Demographic and Health Survey (GDHS) 2008, 14% of children under five years are underweight, 28% are stunted and 9.0% wasted.

Issue 43, July 2012 (page 22)

Emotional Stimulation for acutely and severely malnourished children in SNNPR

Research has shown that the survival rate of malnourished children during food crises critically depends not just on the availability of appropriate therapeutic food, but also on the emotional and physical stimulations available for both the child and the caregiver (usually the mother).

Issue 40, February 2011 (page 85)

ENN report of Washington CTC meeting 2005

A new ENN publication on operational challenges of implementing therapeutic care is now available. The report summarises key elements of the presentations and discussions that took place at the Inter-Agency Workshop on Community Therapeutic Care (CTC) held in March 2005 in Washington, DC.

Issue 27, March 2006 (page 19)

ENN/GIFA project

Summary of presentation.

Issue 19, July 2003 (page 28)

Evaluation of CMAM Pakistan: UNICEF country case study

CMAM has been implemented in Khyber Pakhtunkhwa province of Pakistan, with scale up in 2010 associated with the emergency response to flooding.

Issue 45, May 2013 (page 45)

FANTA-2 reviews of national experiences of CMAM

In 2010 and 2011, FANTA-2 conducted a series of reviews of community based management of acute malnutrition in Mauritania, Burkino Faso, Mali, Niger, Sudan and Ghana.

Issue 43, July 2012 (page 65)

Feeding without fear

This is a story to illustrate that however experienced you are, there is always the chance that you will find yourself in a situation that you are not prepared for, and that you do not feel qualified to deal with.

Issue 10, July 2000 (page 8)

Focus on coverage assessment

During the past 10 years, the management of acute malnutrition has undergone a major paradigm shift that has changed the previous inpatient ‘clinical’ model of care into a community-based “public health” model of care.

Issue 42, January 2012 (page 34)

Foods for the Treatment of Malnutrition

Summary of Conference Presentation.

Issue 2, August 1997 (page 14)

Fortified spreads v CSB in supplementary feeding in Malawi

Summary of published research.

Issue 37, November 2009 (page 10)

Framework for integration of management of SAM into national health systems

In 2010, UNICEF approached VALID International to design and conduct a global mapping review of Community-based Management of Acute Malnutrition (CMAM) with a focus on severe acute malnutrition (SAM).

Issue 43, July 2012 (page 58)

From Pilot to Scale-Up: The CMAM Experience in Nigeria

This article describes the experiences of ACF, Save the Children and UNICEF in supporting government scale up of CMAM programming in Nigeria.

Issue 43, July 2012 (page 90)

From the Editor

A key thematic focus of this issue of Field Exchange is Humanitarian Reform. There have been many reviews and evaluations concerning the level of progress made since the reform process was officially launched some five years ago.

Issue 39, September 2010 (page 2)

From the editor

This Field Exchange special issue on ‘Lessons for the scale up of Community-based Management of Acute Malnutrition (CMAM)’ mainly aims to provide some insights on scaling up CMAM from a government perspective. A large part of this edition is therefore taken up with the proceedings of an international conference on government experiences of CMAM scale up held in Addis Ababa, 14-17 November, 2011.

Issue 43, July 2012 (page 2)

Global CMAM mapping in UNICEF supported countries

Summary of review.

Issue 41, August 2011 (page 11)

GPS assisted coverage survey in DRC

This article describes a modification of the centric systematic area sampling method using GPS, to overcome field constraints related to mapping and active case finding.

Issue 35, March 2009 (page 36)

High OTP coverage through the Ministry of Health in Chad

The community-based management of acute malnutrition (CMAM) has three key public health determinants of impact. The first is access, which is the degree to which patients with severe acute malnutrition (SAM) access treatment (through the out-patient therapeutic programme – OTP) early on in the course of their disease, which leads to uncomplicated cases and results in early recovery.

Issue 45, May 2013 (page 52)

Highlights from MSF-hosted meeting on outpatient and community based therapeutic care

In 2005, Médecins Sans Frontières (MSF) treated more than 60,000 severely malnourished children during the crisis in Niger. Over 70% of the children were cared for on an outpatient basis, using Ready to use Therapeutic food (RUTF).

Issue 27, March 2006 (page 16)

Home Based Treatment of Severe Malnutrition in Kabul

Action Contre la Faim (ACF) has been working in Afghanistan since 1995. The nutrition programme in Kabul includes three therapeutic feeding centres (TFC) within paediatric hospitals in the city, and a network of smaller TFCs providing care close to the population.

Issue 24, March 2005 (page 18)

Home treatment for severe malnutrition in South Sudan

This article details the largely positive experiences of ACF-USA in using home treatment as an integral part of their programme to manage severe malnutrition in South Sudan.

Issue 28, July 2006 (page 18)

Home-Based Therapy With RUTF In Malawi

This article describes the positive experiences of the St Louis Nutrition Project using Ready to Use Therapeutic Food (RUTF) in Malawi, and how this approach was integrated into the existing national network for managing severe and moderate malnutrition.

Issue 21, March 2004 (page 12)

Impact of community mobilisation activities in Uganda

In July 2006, ACF-USA implemented an out-patient programme for the treatment of severely malnourished children in the main internally displaced people (IDP) camps of the districts of Lira and Apac, Northern Uganda.

Issue 34, October 2008 (page 15)

Impact of HIV/Aids on Acute Malnutrition in Malawi

In Malawi, chronic malnutrition (stunting) is estimated at around 50%, although recent studies suggest this has increased substantially and, in some districts, is now around 65%. Rates of underweight are at 25% and acute wasting around 6%.

Issue 25, May 2005 (page 18)

Impact of local RUTF manufacture on farmers’ incomes in Malawi

This article describes the experience of local production of Ready to Use Therapeutic Food (RUTF) in Malawi by Valid Nutrition with regard to economic impact on local farmers.

Issue 38, April 2010 (page 18)

Impact of non-admission on CTC Programme Coverage

This article presents the fi ndings of a preliminary analysis by Valid International of questionnaires and Centric Systematic Area Sampling (CSAS) surveys implemented in seven countries by a variety of agencies and organisations, with a view to investigating the impact of non-admission on estimates of CTC programme coverage.

Issue 31, September 2007 (page 29)

Impact of WHO Growth Standards on SAM response to treatment

Summary of published research.

Issue 35, March 2009 (page 17)

Implementation of WHO Guidelines on the Management of Severe Malnutrition in South Africa and Ghana

Summary of published research.

Issue 20, November 2003 (page 12)

Implications of a Coverage Survey in Ethiopia

This article presents the results of a survey that took place in December 2006 to assess the coverage of a community-based programme and discusses the implications of the fi ndings.

Issue 31, September 2007 (page 11)

Incidence and duration of severe wasting in two African populations

Summary of review.

Issue 38, April 2010 (page 16)

Increase in the shelflife of Plumpy’nut

Aware of the long time it can take for products to reach the field, especially in land-locked countries, Nutriset have been conducting research with a view to increasing the ‘best before’ date of Plumpy’nut.

Issue 19, July 2003 (page 20)

Increasing Access to Ready-to-use Therapeutic Foods (RUTF)

Since 2007, the use of ready to use therapeutic foods (RUTF) to treat severe acute malnutrition (SAM) in young children has been endorsed by the United Nations and non-governmental organisations (NGOs), and received wide notice by the media.

Issue 42, January 2012 (page 47)

Informal workshop on bioavailability of micronutrients in RUTF

Summary of workshop report.

Issue 38, April 2010 (page 22)

Institutional Integration of CTC with existing clinical health systems (Special Supplement 2)

Therapeutic Feeding Centres (TFCs) are often highly effective in treating individual cases of severe malnutrition. Their exacting requirements for hygiene, and delivery of the medical and nutritional protocols means that they are often set up as 'parallel structures,' with little room for local Ministry of Health (MoH) involvement.

Supplement 2, November 2004 (page 51)

Integrated Management of Acute Malnutrition (IMAM) scale up: Lessons from Somalia operations

Somalia has been in a state of armed conflict since 1988, and has been without an effective government since the fall of Siad Barre in 1991, representing the longest case of state collapse in modern times.

Issue 43, July 2012 (page 28)

Integrated management of acute malnutrition in Kenya including urban settings

Kenya has a population of 38.7 million people, of which 5,939,308 are children under five (U5) years of age. The country is divided into eight provinces: Coast, Eastern, Central, North Eastern, Rift Valley, Nyanza, Western and Nairobi.

Issue 43, July 2012 (page 78)

Integrating CTC and HIV/AIDS Support in Malawi

This article describes the research findings1 of the first phase of a two-part study in Malawi by Valid International, which is exploring how existing CTC programmes can be adapted in the context of HIV/AIDS.

Issue 25, May 2005 (page 7)

Integrating CTC in health care delivery systems in Malawi (Special Supplement 2)

In February 2002, the Malawi government declared a national nutritional emergency and the UN launched an international appeal for emergency assistance.

Supplement 2, November 2004 (page 19)

Integrating OTP into routine health services CONCERN’s experiences

This article describes the history of an international non-governmental organisation (INGO)-implemented programme that evolved from an innovative emergency intervention into a longer-term initiative, to support the Ministry of Health (MoH) to integrate treatment services for Severe Acute Malnutrition (SAM) within the routine health system.

Issue 40, February 2011 (page 69)

Integration in CTC (Special Supplement 2)

Many of the articles in this supplement explore the concepts and practice of 'integration' within CTC programmes. A variety of meanings and values are attached to the word 'integration' in this context.

Supplement 2, November 2004 (page 41)

Integration of CMAM into routine health services in Nepal

This article describes a pilot project by Concern Worldwide in Bardiya district, Nepal to integrate CMAM into routine health services directly, without the more typical transition from an NGO led programme.

Issue 39, September 2010 (page 33)

Integration of CTC with strategies to address HIV/AIDS (Special Supplement 2)

Home-Based Care (HBC) is now seen as the way forward for caring and supporting People Living With HIV/AIDS (PLWHA) and HIV affected households (30;31).

Supplement 2, November 2004 (page 49)

Integration of the management of severe acute malnutrition in health systems: ACF Guidance

The management of severe acute malnutrition (SAM) has improved substantially in recent years. However, despite these improvements coverage remains shockingly low. There has been a realisation that treatment can only be achieved at scale by ensuring the availability of and access to treatment at all levels of the health system and community (task shifting).

Issue 43, July 2012 (page 62)

Inter-Agency Meeting on Community Therapeutic Care

FANTA, SC US and Concern hosted an inter-agency meeting on Community Therapeutic Care between February 28th and March 2nd, 2005 in Washington.

Issue 24, March 2005 (page 14)

International Workshop on Integration of CMAM

The International Workshop on the Integration of Community-Based Management of Acute Malnutrition (CMAM), held between 28th and 30th of April 2008, was the third in a series of workshops on CMAM over the past five years.

Issue 34, October 2008 (page 16)

Introduction (Special Supplement 2)

This supplement presents a collection of articles written by people who have been involved in Community-based Therapeutic Care (CTC) programmes.

Supplement 2, November 2004 (page 4)

Joint UN Statement on Community-based Management of Severe Acute Malnutrition

A Joint Statement by the World Health Organization (WHO), the World Food Programme (WFP), the United Nations System Standing Committee on Nutrition (UNSCN) and UNICEF on Community-based Management of Severe Acute Malnutrition has been released.

Issue 31, September 2007 (page 16)

Letter on background to 1999 WHO guidelines on malnutrition, by Mike Golden

Further to your article on the technical debate regarding the management of severe malnutrition, I wish to offer some contextual information to the development of the World Health Organisation (WHO) guidelines, and agency field protocols.

Issue 20, November 2003 (page 18)

Letter on commercial production of RUTF, by Michel Lescanne


Issue 24, March 2005 (page 17)

Letter on inadequate coverage of SAM in Lancet Undernutrition Series, by Susan Shepherd


Issue 33, June 2008 (page 24)

Letter on local v imported therapeutic milk, by Rebecca Norton and Jean-Pierre Papart (with responses by Mike Golden, Ann Ashworth, Mary Lung'aho and David Sanders)

Letter from the Nutrition/health advisors of Fondation Tdh.

Issue 31, September 2007 (page 18)

Letter on MSF guidelines on using F75, Saskia van der Kam, Aranka Anema, Sophie Baquet and Marc Gastellu

MSF would like to thank Schofield et al for their constructive criticism in the letter section of the previous edition of Field Exchange.

Issue 15, April 2002 (page 9)

Letter on nomenclature in CTC programmes, by Steve Collins


Issue 24, March 2005 (page 16)

Letter on nomenclature used in malnutrition programmes, by Mike Golden


Issue 24, March 2005 (page 15)

Letter on revised MSF Nutrition Guidelines draft, by E.C. Schofield, Ann Ashworth, Mike Golden and Y. Grellety

Revised MSF nutrition guidelines.

Issue 14, November 2001 (page 21)

Letter on standards for severe malnutrition mangement, by Kiross Tefera, with response by Saskia van der Kam

First my gratefulness goes to Professor Michael Golden and Yvonne Grellety for their detailed and scientific article based on the research outcome of about 8500 children comparing the observed to expected mortality rate done in different therapeutic feeding institutions (Field exchange, issue 15, April 15, pp. 12-13).

Issue 16, August 2002 (page 20)

Linear programming to design low cost, local RUTF

Summary of research.

Issue 43, July 2012 (page 37)

Local and centralised therapeutic food production

Summary of editorial.

Issue 37, November 2009 (page 8)

Local Production of Plumpy’Nut

The French company, Nutriset, has been involved in projects aimed at establishing local production of Plumpy’nut - a ready-to-use food product (RTUF) employed in feeding programmes for the management of severe malnutrition.

Issue 20, November 2003 (page 14)

Local Production of RUTF (Special Supplement 2)

The development of RUTF has been an important factor facilitating the development of CTC. However at the moment, most RUTF is made in France, is marketed at a high cost and incurs considerable transport overheads to move it to the point of use.

Supplement 2, November 2004 (page 33)

Local versus industrially produced therapeutic milks in managing severe malnutrition

For the past eight years, Fondation Terre des hommes (Fondation Tdh) have been working in Mauritania, opening a nutritional unit for managing acute malnutrition in 2000.

Issue 34, October 2008 (page 13)

Locally produced RUTF in a hospital setting in Uganda

This article describes some of the preliminary findings of a recent study that introduced locally produced Ready to Use Therapeutic Food (RUTF) into a hospital setting in Uganda, comparing its use to F100 during the rehabilitation phase. This article focuses particularly on the experiences producing local RUTF in a hospital setting, including cost comparisons with the routinely used F100.

Issue 28, July 2006 (page 22)

Malaria Treatment in Severe Malnutrition in Angola

This field article outlines the results of a preliminary study carried out by ACH in Angola, which showed poor response rates to standard TFC protocols for managing malaria.

Issue 21, March 2004 (page 3)

Malaria: The Iron and Folate Debate.

Marion Kelly summarised recent deliberations among NGOnut contributors in relation to the administration of iron (and folate) in malaria endemic areas. Below is her summary in point format. .

Issue 4, June 1998 (page 30)

Management of acute malnutrition in Niger: a countrywide programme

Niger is a land-locked Sahelian country with a population of over 15 million people, of which approximately 50 per cent are children under 15 years of age. Niger ranks 173rd out of 177 countries according to the 2010 UNDP1 Human Development Index.

Issue 43, July 2012 (page 52)

Management of acute malnutrition programme review and evaluation

Summary of evaluation.

Issue 43, July 2012 (page 83)

Management of moderate acute malnutrition with RUTF in Niger

Between 2001 and 2005, the Médecins Sans Frontières (MSF) therapeutic feeding programme in Maradi.

Issue 31, September 2007 (page 3)

Managing severe acute malnutrition in high HIV prevalence areas

Summary of research.

Issue 34, October 2008 (page 7)

Managing severe acute malnutrition in India: prospects and Challenges

This article is based on a case study and presentation delivered by Biraj Patnaik for the Addis Ababa Conference on CMAM scale up in November 2011. He describes the scale of nutritional problems in India, current institutional mechanisms, and challenges in addressing the SAM burden in particular. Jamie Lee and Bernadette Feeney (Valid International) were invited by the India delegation to describe a number of developments in India since the conference around CMAM that are shared in a postscript.

Issue 43, July 2012 (page 85)

Mental Health among Children in Severe Food Shortage Situations

A paper on the ‘Mental Health and Psychosocial Well–Being among Children in Severe Food Shortage Situations’ has been prepared in a WHO inter-departmental collaboration.

Issue 31, September 2007 (page 15)

Miscalculation of the Prevalence of Acute Malnutrition in Surveys with Oedematous Children

Unpublished paper.

Issue 24, March 2005 (page 8)

Mortality risk factors in severelymalnourished children hospitalised with diarrhoea

Summary of published research.

Issue 42, January 2012 (page 13)

New Measuring Scoops for F75 Therapeutic Milk

To respond to frequent requests for measuring scoops for the preparation of small quantities of F-75, Nutriset with the approval of UNICEF, are including measuring scoops in every carton of F-75.

Issue 22, July 2004 (page 16)

New Method for Estimating Programme Coverage

This article gives an overview of the coverage estimation method developed for the Community Therapeutic Care (CTC) Research Programme in Malawi.

Issue 21, March 2004 (page 11)

Nutrition in the DPRK - a field view

This article, provides an 'experience based' sequel to Field Exchange's analysis of the DPRK crisis (see issue 3). It casts doubt on claims of widespread malnutrition, focuses on the appalling state of care available to chronically malnourished children, and highlights the considerable operational difficulties in running nutritional programmes in DPRK.

Issue 5, October 1998 (page 21)

Nutritional Status of HIV+ Pre-School Children in South Africa

Summary of unpublished research.

Issue 22, July 2004 (page 10)

Operational study on SAM management in high HIV prevalence area

Summary of published research.

Issue 34, October 2008 (page 12)

Outpatient therapeutic programme (OTP): an evaluation of a new SC UK venture in North Darfur, Sudan (2001)

Summary of internal evaluation by Anna Taylor (headquarters nutrition advisor for SC UK).

Issue 16, August 2002 (page 26)

Postscript on local capacity building for treatment of severe malnutrition

International NGOs usually provide better treatment for children with severe malnutrition in their feeding centres than is provided by local hospitals.

Issue 17, November 2002 (page 22)

Postscript to: 'A pragmatic approach to managing severe malnutrition: Is F75 always beneficial?'

It is quite wrong to consider the advantage of F75 as “theoretical”.

Issue 15, April 2002 (page 12)

Postscript: Local purchase of ingredients for RUTF in developing countries?

The manufacture of Ready to Use Food (RUTF) in developing countries, using ingredients purchased from local farmers, has always been a central element in the Community-based Therapeutic Care (CTC) model.

Issue 38, April 2010 (page 20)

Prise en charge de la malnutrition aiguë au Niger : Un programme national (français)

Le Niger est un pays enclavé du Sahel, avec une population de plus de 15 millions de personnes, dont environ 50% sont des enfants de moins de 15 ans. Le Niger se classe au 173e rang sur 177 selon l’Indice de développement humain du PNUD 2010.

Issue 43, July 2012 (page 52)

Probiotics and prebiotics for SAM in Malawi

Summary of research.

Issue 37, November 2009 (page 10)

Putting nutrition products in their place: ACF position paper

Summary of position paper.

Issue 42, January 2012 (page 58)

Qualitative review of an alternative treatment of SAM in Myanmar

In 2009, Action Contre la Faim (ACF) treated an estimated 18,000 children under five years for severe acute malnutrition (SAM) in Maungdaw and Buthidaung Townships and Sittwe, Rakhine state, western Myanmar.

Issue 42, January 2012 (page 7)

Quantitative and qualitative analysis of CTC programme coverage

Summary of published research.

Issue 39, September 2010 (page 19)

Quantity through quality: Scaling up CMAM by improving programmes Access

ACF International’s strategy for scaling up nutrition programming is underpinned by one simple idea: we are not reaching enough of the affected population.

Issue 44, December 2012 (page 46)

Ready to use therapeutic food for treatment of marasmus

Summary of published letter.

Issue 8, November 1999 (page 8)

Regional CMAM meeting in Ethiopia 2011

In collaboration with the Government of Ethiopia and in consultation with national and international agencies, the Emergency Nutrition Network (ENN) is planning a three day regional meeting on the scale-up of community based management of acute malnutrition (CMAM), to be held in Addis Ababa in November 2011.

Issue 40, February 2011 (page 81)

Relief Food Factory to Open in Kenya

Pan-African food giant Promasidor is setting up a Ksh 550 million relief food factory in Kenya.

Issue 23, November 2004 (page 16)

Remote monitoring of CMAM programmes coverage: SQUEAC lessons in Mali and Mauritania

Action Against Hunger (ACF) currently supports community based management of acute malnutrition programmes (CMAM) programmes in over 20 countries around the world, with a long-standing presence in the Sahel region of West Africa, including Mauritania, Niger, Mali and Chad.

Issue 42, January 2012 (page 35)

Response on F-75 and use of measuring scoops

Since 1986, Nutriset has been very involved in seeking practical solutions for the development of quality nutritional products.

Issue 32, January 2008 (page 14)

Review of CMAM in Ethiopia, Malawi and Niger

Summary of research.

Issue 33, June 2008 (page 11)

RUTF use in adults in Kenya

Summary of meeting abstract.

Issue 34, October 2008 (page 10)

Scaling up CMAM in the wake of 2010 floods in Pakistan

The Islamic Republic of Pakistan is the sixth most populous country in the world (>180 million in 2011), the second largest Muslim population after Indonesia and has wide diversity in terms of culture, ethnicity, language, geography and climate. Pakistan is a federal parliamentary republic consisting of four provinces and four federal territories.

Issue 43, July 2012 (page 67)

Scaling up the treatment of acute childhood malnutrition in Niger

This article presents a strong case from Niger that managing severe malnutrition on a large scale through outpatient treatment is a real possibility.

Issue 28, July 2006 (page 3)

Should Iron Supplementation be Daily or Weekly?

Two published papers.

Issue 3, January 1998 (page 7)

SQUEAC in routine monitoring of CMAM programme coverage in Ethiopia

The development of community-based management of acute malnutrition (CMAM) was a significant advance in the treatment of severe acute malnutrition and associated child mortality.

Issue 38, April 2010 (page 35)

SQUEAC: Low resource method to evaluate access and coverage of programmes

Centric Systematic Area Sampling (CSAS) was developed to estimate coverage of selective feeding programmes.

Issue 33, June 2008 (page 3)

Study of the Risk Factors for the Development of Nutritional Oedema in North Kivu, DRC

This article is based on findings of a report written by Mark Myatt which, in turn, is based on the findings of research undertaken by Save the Children UK in DRC.

Issue 26, November 2005 (page 5)

Suggested New Design Framework for CMAM Programming

The last fifteen years have seen unprecedented progress in the field of management of severe acute malnutrition (MSAM).

Issue 39, September 2010 (page 42)

Technical and Management issues within CTC (Special Supplement 2)

CTC case studies.

Supplement 2, November 2004 (page 28)

The CTC Advisory Service: Supporting the Countrywide Scale-up of CTC in Malawi

In response to a food shortage in 2002, Concern Worldwide and Valid International piloted a Community-based Therapeutic Care (CTC) project in two districts in Malawi.

Issue 35, March 2009 (page 18)

The new role of Nigerien medical NGOs in treating SAM

Niger has been affected by a persistent nutritional crisis, as documented over the past five years, with rates of severe acute malnutrition (SAM) consistently above critical thresholds. Child and infant mortality remains extremely high at 160 per 1,000 persons.

Issue 41, August 2011 (page 59)

Therapeutic challenges and treatment of hypovolaemic shock in severe malnutrition

Summary of proceedings.

Issue 38, April 2010 (page 17)

Therapeutic feeding centres - Routine Antibiotics ?

Routine prescription of antibiotics to all TFC admissions regardless of clinical presentation (as recommended by WHO protocol ) seems rather extreme. What are the benefits and risks involved?.

Issue 4, June 1998 (page 23)

Therapeutic Feeding: Imported Versus Local Foods

Steve Collins recently drew attention to a situation in Haiti where the only food being used (i.e.,F100) in the treatment of severe malnutrition became unavailable. Health staff subsequently adopted dangerous treatment approaches (i.e., dextrose-saline drips) which resulted in higher mortality rates (>70%) amongst kwashiorkor patients.

Issue 4, June 1998 (page 30)

Training and workshop to integrate IYCF in CMAM

Summary of report.

Issue 40, February 2011 (page 82)

Transforming awareness and training into effective CMAM Performance

In February 2011, Action Against Hunger ACF International (ACF) began supporting a sustainable approach to integration of community-based management of acute malnutrition (CMAM) in three Local Government Areas (LGAs) in Yobe State, Nigeria.

Issue 45, May 2013 (page 43)

Treating severe malnutrition in nonemergency situations: Experiences from Malawi and Guinea

The article below highlights the difficulties of providing effective treatment for severe malnutrition in non-emergency situations within local health structures based on experiences in Malawi and Guinea.

Issue 17, November 2002 (page 20)

Treatment of severe malnutrition in Tanzania - a problem with ‘scoops’

This article describes practical problems in preparing therapeutic milk in a hospital-based setting and makes some suggestions to resolve them.

Issue 32, January 2008 (page 13)

Treatment of severe malnutrition now a core competency in health

Paediatricians took a giant step forward at the International Paediatric Association (IPA) Congress in Johannesburg in August 2010 when they resolved that treatment of malnutrition should become a core competency. It also had the support of the WHO, UNICEF and other United Nations agencies.

Issue 40, February 2011 (page 80)

Treatment of Severe Malnutrition with a Therapeutic Spread

On going Research.

Issue 2, August 1997 (page 15)

Trials and tribulations of local RUTF producer in Haiti

This article presents Meds & Food for Kids, an independent local producer of therapeutic and supplementary foods in Haiti, and its pursuit of accreditation as a manufacturer of Ready to Use Therapeutic Food and acceptance in international supply chains. This story serves as a backdrop to a wider conversation on the viability of the national production model for Ready to Use Foods, and the obstacles and opportunities that are present for specialised manufacturing in developing world contexts.

Issue 39, September 2010 (page 10)

UNHCR feeding programme performance in Kenya and Tanzania

Routine monitoring data are available from the many nutrition programmes operating in camps supported by UNHCR, typically growth monitoring programmes, under the Expanded Programme on Immunisation, MUAC based household surveillance, Supplementary Feeding Programmes (SFPs) and community based therapeutic feeding programmes (TFPs).

Issue 44, December 2012 (page 28)

UNICEF Global reporting update: SAM treatment in UNICEF supported countries

Following the CMAM mapping exercises of 2009 and 2011, UNICEF and Valid International are working together through a UNICEF-supported Project Cooperation Agreement (PCA). Thanks to Erin Boyd (UNICEF), Nicky Dent (Valid International),James Hedges (UNICEF HQ), Gideon Jones (Valid International), and Rachel Lozano for contributing to this article.

Issue 43, July 2012 (page 38)

Updated Nutriset ‘red scoop’ instructions for mixing F75 and F100

Nutriset’s F-75 and F-100 therapeutic milks come in sachets of, respectively, 410 g and 456 g. For both products, the full content of one sachet must be mixed with 2 litres of boiled/potable water to obtain 2.4 litres of therapeutic milk.

Issue 39, September 2010 (page 29)

Use of commercial RUTF in India

Summary of publication.

Issue 37, November 2009 (page 13)

Valid Nutrition

The ENN recently interviewed Steve Collins and Paul Murphy from Valid Nutrition (VN) at a Central London Hotel.

Issue 39, September 2010 (page 46)

Valid Nutrition and Insta Products announce collaboration in East Africa

Valid Nutrition (VN) and Insta Products EPZ Limited (Insta) have entered into a collaboration in East Africa covering the provision of Ready to Use Foods (RUF) within the region.

Issue 34, October 2008 (page 19)

Value chain approach to increase production of RUTF/CSB

In Ethiopia, 13.7 million people face chronic food insecurity. Out of this figure, the number of people who needed emergency food aid reached about 6.2 million in June 2009. An additional 7.5 million received aid in return for work on community projects as a part of the Productive Safety Net Programme (PSNP).

Issue 40, February 2011 (page 79)

WHO meeting report on community-based management of severe malnutrition

A meeting of experts was organised by the Department of Child and Adolescent Health and Development and the Department of Nutrition for Health and Development of the WHO, by UNICEF and by the UN Standing committee on Nutrition in Geneva on 21-23 November 2005.

Issue 28, July 2006 (page 14)

WHO/TALC materials on the Management of Severe Malnutrition

Given the recent debate and rapidly evolving developments in the management of severe malnutrition, knowledge of current guidelines and training materials and how to access them is essential for field workers.

Issue 22, July 2004 (page 15)

Why coverage is important: efficacy, effectiveness, coverage, and the impact of CMAM Interventions

Community-based Management of Acute Malnutrition (CMAM) has reached a crucial point in its evolution. What began as a pilot study just over a decade ago, is now a cornerstone of nutrition policy in over sixty countries.

Issue 45, May 2013 (page 40)

Why have mortality rates for severe malnutrition remained so high?

During food emergencies, agencies often have to decide at what point Therapeutic Feeding Programmes (TFPs) should be closed. .

Issue 1, May 1997 (page 10)

Workshop on the Integration of Community-based Management of Acute Malnutrition (CMAM)

The Food and Nutrition Technical Assistance (FANTA) Project is hosting a Community-based Management of Acute Malnutrition (CMAM) international workshop in Washington DC, sponsored by USAID’s Office of Foreign Disaster Assistance and Office of Health, Infectious Diseases and Nutrition.

Issue 32, January 2008 (page 21)

World Vision programme for severe acute malnutrition in SNNPR

World Vision Ethiopia (WVE) is a non-governmental organisation (NGO) that has been working in Ethiopia implementing crosssectoral relief, rehabilitation and development programmes since 1971.

Issue 40, February 2011 (page 53)