Infants under six months of age are often excluded from nutrition surveys and programmes. This is because it is assumed that these children are exclusively breastfed and are therefore rarely malnourished.
Routine screening for acute malnutrition is traditionally reserved for children aged 6-59 months. However, in nutritional recovery units in the region of Kayes in Mali, 3% of children are infants under six months and 39% are between six and nine months old. Moreover, it is likely these figures are underestimated given the lack of routine early diagnosis in children under six months.
In order to better assess and understand the magnitude of the problem, Action Against Hunger Spain has developed a partnership with the National Directorate of Health, the Health District Executive Teams, and the National Institute for Research in Public Health in Mali.
A total of 31 health professionals (DTC, vaccinators, nutrition staff and nurses) and 24 of Action Against Hunger’s nutrition staff were trained on the Community Management of At-Risk Mothers and Infants (C-MAMI) tool between July and September 2018. The training materials and support tools, for example new WHO growth charts, vulnerability scorecards, and registration and management sheets, were made available to Community Health Centres in the project’s intervention areas.
A key component of the intervention was finding infants with acute malnutrition. For that purpose 187 community actors (community health workers and GSAN members) were trained on screening and referral of children under six months of age following the research protocol in the project intervention areas.
During the project 217 children under six months of age were screened by community health workers and GSANs using Shakir strips. These are bands that wrap around infants arms to detect malnutrition. Among those, 54 mother-infant couples were supported according to the C-MAMI approach.
Our project required a series of steps to be successful. These included training, distribution of supporting tools, and active finding of newborns. Training different actors in the implementation of the C-MAMI approach was key to help them understand the new tool and eased the identification and management of registered cases.
Supervision activities contributed to an improvement in the way that mother-infant couples enrolled in the programme were managed. On top of that, the replication and distribution of supporting documents helped the collection of data. This contributed to sources of verification for vulnerability assessment and programme enrolment being established. Finally, the monitoring of new live births made it possible to orient screening activities in the villages.
Among health personnel, this approach improved understanding about the care of malnourished children under six months without complications or at risk of malnutrition.
It has proven that outpatient management of these cases through the C-MAMI tool can be successful and viable. Furthermore, the participation of GSAN in the screening and referral of these children allowed the integration of this approach in the current Infant and Young Child Feeding (IYCF) practices. It also made it possible to set up breastfeeding counselling support for lactating women.
In the future, Action Against Hunger plans to continue to carry out joint supervisions with the local health authorities to assess the quality of child care practices. We will also look into the recovery of nutritional status and the evaluation of the causes of defaulting.
Action Against Hunger with the Ministry of Health of Mali will develop and validate a methodological approach adapted to the context to scale up the intervention.
Photo Credit: ACF
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