Updated C-MAMI Tool now available
The C-MAMI (Community Management of At risk Mothers and Infants under six months of age) Tool provides a health worker with a format to assess and manage at risk mothers and infants under six months of age in the community1 who are nutritionally vulnerable. Version 1 was developed by ENN, LSHTM, Save the Children and collaborators in 2015 to help fill a gap in programming guidance and catalyse case management. It has been used in several contexts since; these experiences and expert peer review have informed an update by ENN, LSHTM, Save the Children, GOAL and collaborators2 to produce Version 2.0 (July 2018), funded by Save the Children and ENN (Irish Aid).
The format of the tool is modelled on the Integrated Management of Childhood Illness (IMCI) approach to facilitate integration. It may require adaptation, development of programme-specific materials and different levels of training for implementation. It is applicable in both humanitarian and development settings.
Guiding principles governing the C-MAMI Tool management approach include:
- The term ‘enrolment’ rather than ‘admission’ is used, to avoid medicalising community level support to these infants.
- Feeding support and social support is central to outpatient management.
- The MAMI approach always considers the mother-infant pair.
- Anthropometric criteria are useful but have limitations in this age group. Feeding, clinical and maternal factors are more important to assess, guide actions and to determine discharge.
- Clinical status of infants and their medical management is particularly critical; first line action is triage to identify and refer ‘complicated’ cases.
- The terms ‘severe’ and ‘moderate’ acute malnutrition are not applied to this age group.
- Skilled breastfeeding support, is critical to case management. Non-breastfed infants need special support and follow-up.
- Currently there are no agreed MUAC cut-offs for infants < 6 months. The tool recommends collecting MUAC data to help build the evidence base.
The C-MAMI package comprises:
- C-MAMI Tool v2.0
- Counselling and support actions booklet
- Counselling cards
- C-MAMI enrolment and management card
The C-MAMI Tool is available in English here. A word version, to facilitate adaptation, is available on request. Please contact us with feedback and experiences of using the tool, and if you are interested in/planning field testing or translation.
Contact: Marie McGrath, ENN.
Endnotes
1In 2017, MAMI was redefined from ‘management of acute malnutrition in infants U6m’ to ‘management of at risk mothers and infants U6m’ to reflect the profile of infant-mother pairs being identified, their associated risks, and consequently the wider scope of interventions needed to cater for/support them; these include but are not limited to nutrition.
2Content update was coordinated by ENN (Marie McGrath), led by Save the Children consultants (Mary Lung’aho & Maryanne Stone Jimenez (Nutrition Policy and Practice)), in close collaboration with Marko Kerac (LSHTM); Nicki Connell, Sarah Butler (Save the Children), Hatty Barthorp (GOAL) and with input from working groups formed within the MAMI Special Interest Group and expert contributors, namely: Alice Burrell (Save the Children), Alison Talbert (KEMRI-Wellcome, Kenya), Cecile Bizouerne (ACF), Elizabetta Dozio (ACF), Indi Trehan, Jay Berkley (KEMRI-Wellcome, Kenya), Karine le Roch (ACF), Katie Beck (Partners in Health), Kirrily de Polnay (MSF), Louise Day (LSHTM), Martha Mwangowe (KEMRI-Wellcome, Kenya), Natalie (MSF), Nigel Rollins (WHO), Robert Stewart (University of Edinburgh), Zita Weise Prinzo (WHO).