Tracking Progress on Child and Maternal Nutrition - Unicef

Community-based management of
severe acute malnutrition in Malawi
In Malawi each year, there are an estimated 59,000 children
with severe acute malnutrition. Around 59 per cent of
these children are currently being treated, at a recovery
rate of more than 75 per cent, which makes Malawi a
leader globally in achieving results in the management of
severe acute malnutrition. A vital component of Malawi’s
success has been the introduction of community-based
management of the condition.
Poor nutritional status has been a chronic problem in
Malawi. In addition to endemic diseases and the AIDS
epidemic, from 2001–2006 Malawi experienced persistent
episodes of food shortage and other humanitarian crises.
The rate of global acute malnutrition nationally was
6.2 per cent in 2005; four districts had rates above
10 per cent. Prior to 2006, management of severe acute
malnutrition took place on an inpatient basis in paediatric
wards and in nutrition rehabilitation units using the
milk-based therapeutic preparations.
In 2002, however, the non-governmental organizations
Concern Worldwide and Valid International introduced an
innovative approach using ready-to-use therapeutic food
to increase coverage of treatment for severe acute
malnutrition. The initiative, anchored at the district level,
encourages communities to identify severely undernourished
children before they require inpatient care. Effective
treatment is then given on a weekly basis at local health
structures or at distribution sites within a day’s walk of
people’s homes. Inpatient care is available for complicated
cases.
These efforts led to expanded coverage of effective
treatment, reaching 74 per cent of those in need,
compared to 25 per cent for the traditional approach.
After extending the initiative to additional districts
following a 2004 review, the model was adopted as a
national strategy in 2006, and its gradual scale-up and
integration into the primary-health-care system began. By
March 2009, the programme had been scaled up to 330
outpatient and 96 inpatient sites in all of the country’s 27
districts, and it is expected to eventually reach all health
facilities in the country.
Sources: Community-based Management of Severe Acute Malnutrition: A joint
statement by the World Health Organization, the World Food Programme, the
United Nations System Standing Committee on Nutrition, and the United Nations
Children’s Fund, WHO, WFP, SCN and UNICEF, Geneva, Rome and New York,
May 2007; and UNICEF Malawi Country Offi ce Annual Reports and other
internal documents.
32 <strong>Tracking</strong> <strong>Progress</strong> on Child and Maternal Nutrition
In many countries and communities, households face
periods of seasonal food shortage, or adequate nutritious
food may be unavailable to families on a continual basis.
This situation needs to be addressed in order to ensure
adequate maternal nutrition and complementary feeding
for infants and young children, as well as to sustain reductions
in undernutrition over the long term. Interventions
include measures to improve agricultural production and to
increase food availability through social protection schemes
and food distribution programmes.
The table on the following pages offers detailed information
on the priority interventions for the prevention of undernutrition
and the treatment of severe and moderate acute
malnutrition to be delivered at stages of the life cycle
between the woman’s pregnancy and the child’s second
birthday. Some of these preventive actions should begin
in adolescence, before the woman becomes pregnant, and
continue after the child reaches 24 months of age. Many of
these interventions endeavour to change behaviour and will
depend on the successful implementation of large-scale
communication strategies.
Adequate nutrition is also of key importance for children
more than 2 years old, and interventions such as vitamin A
supplementation, zinc treatment for diarrhoea, management
of acute malnutrition, and communication and counselling
on the prevention of both undernutrition and overweight
are also crucial for these children.