Assignment: Management of Moderate
and Severe Acute Malnutrition
According to IMAM Guidelines
Introduction
Malnutrition remains a critical public health concern, particularly in low-income countries
where food insecurity, poor sanitation, and limited access to healthcare persist. Acute
malnutrition, which includes both Moderate Acute Malnutrition (MAM) and Severe Acute
Malnutrition (SAM), significantly contributes to child morbidity and mortality. The
Integrated Management of Acute Malnutrition (IMAM) framework was developed to
streamline the identification, treatment, and prevention of acute malnutrition using a
standardized, community-based approach. This assignment critically reviews the evidence-
based strategies recommended in the IMAM guidelines for managing MAM and SAM.
1. Understanding Acute Malnutrition
Acute malnutrition is classified based on anthropometric measurements and clinical signs.
It is divided into two main categories: MAM and SAM. The differentiation is essential for
appropriate intervention, as each condition requires a different level of care and nutritional
support.
Classification criteria include:
• Moderate Acute Malnutrition (MAM): WHZ between -2 and -3, MUAC between 115 mm
and 125 mm.
• Severe Acute Malnutrition (SAM): WHZ below -3, MUAC less than 115 mm, or bilateral
pitting edema.
2. Management of Moderate Acute Malnutrition (MAM)
MAM affects a larger proportion of children than SAM and, if untreated, can progress to
more severe forms. According to the IMAM guidelines, MAM is managed through
community-based Supplementary Feeding Programs (SFPs). These programs target
children aged 6–59 months and pregnant or lactating women.
Core strategies include:
• Provision of RUSFs or fortified blended foods (e.g., Super Cereal Plus).
• Nutrition education and counseling to caregivers on food diversity and meal
frequency.
• Regular anthropometric monitoring (MUAC, weight, height) every two weeks.
• Community-based screening and follow-up by trained health volunteers.
"Nutrition is not just about feeding the hungry. It is about
nourishing a generation." – Tanzania IMAM Guidelines (2018)
3. Management of Severe Acute Malnutrition (SAM)
SAM is a life-threatening condition requiring urgent attention. The IMAM guidelines
recommend two levels of care: Outpatient Therapeutic Programs (OTP) for children without
complications and Inpatient Therapeutic Care for those with complications such as
infections, loss of appetite, or severe edema.
Outpatient Management (OTP):
• Children are given Ready-to-Use Therapeutic Foods (RUTFs), such as Plumpy’Nut.
• Weekly visits to health facilities for monitoring and counseling.
• Screening for infections and supplementation with vitamin A, folic acid, and
deworming.
Inpatient Care:
• Admission to Therapeutic Feeding Units (TFUs) for stabilization.
• Treatment includes F-75/F-100 therapeutic milk, IV fluids, antibiotics, and
micronutrients.
• Children are transitioned to RUTFs upon recovery of appetite and improvement in
vital signs.
4. Role of Community in IMAM Implementation
Community participation is central to the success of the IMAM program. Community Health
Workers (CHWs) are trained to screen children using MUAC tapes, identify cases early, refer
them for treatment, and follow up at home. Health education sessions are conducted
regularly to improve feeding practices and hygiene.
Mobilizing community leaders and integrating IMAM into routine health services ensures
sustainability and local ownership.
5. Discharge Criteria and Follow-Up
According to the IMAM guidelines, a child is discharged from MAM care once they achieve
MUAC ≥ 125 mm and show no signs of illness for two consecutive visits. SAM cases are
discharged when WHZ is ≥ -2 or MUAC ≥ 125 mm for two weeks without edema. After
discharge, children are enrolled in follow-up programs to prevent relapse and support full
recovery.
6. Recommendations and Conclusion
For the successful management of acute malnutrition, the IMAM strategy must be effectively
implemented with adequate supplies, trained personnel, and community involvement.
Government and partner support is essential to ensure coverage, quality, and integration
with other child health interventions. Preventative strategies, such as improving food
security, promoting exclusive breastfeeding, and enhancing maternal education, are crucial
in addressing the root causes of malnutrition.
7. Challenges in IMAM Implementation
Despite the comprehensive approach of IMAM, several challenges affect its implementation,
particularly in low-resource settings. These include inadequate funding, stock-outs of
therapeutic foods, limited trained personnel, and poor infrastructure in remote areas.
Stigma associated with malnutrition and lack of awareness among caregivers also hinder
early detection and timely intervention.
To overcome these challenges, it is essential to strengthen the health system, ensure
consistent supply chains, and promote multi-sectoral collaboration involving health,
agriculture, education, and water sanitation sectors.
8. Example IMAM Workflow (Illustration)
Below is an illustrative example of an IMAM workflow showing the flow of activities from
community screening to treatment and discharge. (Note: Insert diagram manually if
required.)
[Insert IMAM Workflow Diagram Here]
References
Tanzania Food and Nutrition Centre (TFNC). (2018). National Guidelines for Integrated
Management of Acute Malnutrition (IMAM). Retrieved from
https://www.tfnc.go.tz/uploads/publications/en1552987122-National%20IMAM
%20Guideline%20%2015%20February%202018.pdf
World Health Organization (WHO). (2013). Guideline: Updates on the management of
severe acute malnutrition in infants and children. Geneva: WHO.
