Key Messages of IMAM (Integrated Management of Acute Malnutrition) Program

  • IMAM stands for Integrated Management of Acute Malnutrition.
  • It is an integrated program to fight back against acute malnutrition.
  • It is a nutritional program designed especially for children of 6-59 months of age and is a very important concept for management of malnutrition.
  • Although there are lot of technical knowledge and skills required to implement this program effectively, in this article we will only guide you throughout the key messages and knowledge related to it. This will certainly help you understand the crux of the program and at the same time providing you with simple yet essential information.

Principles of IMAM Program:

IMAM program is based on four key principles:

  1. Maximum coverage and access
  • Increasing the coverage of the program up to the community level
  • Decentralization of services
  • Introduction of Out-patient Therapeutic Centre (OTC)
  1. Timeliness
  • Providing timely services through effective community mobilization
  • Timely identification, referral and treatment of malnourished cases
  1. Appropriate medical care and nutritional rehabilitation
  • Medical care and treatment of cases as per the requirement
  • Treatment of Severe Acute Malnutrition (SAM) cases without complications in OTC
  • Treatment of SAM cases with complications in Inpatient Therapeutic Care (ITC). It is also known as Stabilization Center (SC).
  1. Care for as long as it is needed
  • Providing care and support as much as required
  • It helps to reduce the defaulter and relapse of cases

Components of IMAM Program:

Additionally, IMAM program has four components. They are:

  1. Community Outreach/mobilization
  2. Outpatient treatment of SAM without complication i.e. treatment of SAM children under supervision of health worker but not admitting in the health facility
  3. In-patient treatment of SAM with complication i.e. treatment of SAM patient by admitting in the health facility (hospital/stabilization center)
  4. Management of Moderate Acute Malnutrition

Target group of IMAM program:

  • 6-59 months age children
  • Children above 59 months (for special cases of HIV/AIDS, Severe acute malnutrition and edema)

Assessment of Acute Malnutrition:

Acute Malnutrition in a child can be assessed/identified by:

  • Measuring Mid Upper Arm Circumference (MUAC) using MUAC tape/ Shakir tape
  • Checking bilateral pitting edema
  • Measuring height and weight of the child

Decision making for Severe Acute Malnourished (SAM) and Moderate Acute Malnourished (MAM) child:

A child is SAM case if he/she meet any of the following criteria:

  • Presence of bilateral pitting edema OR
  • MUAC measurement of <115mm (<11.5 cm) OR
  • Weight for height Z-score of <-3 S.D

A child is MAM case if he/she meet any of the following criteria:

  • MUAC measurement of greater than or equal to 115mm to less than 125mm OR
  • Weight for height Z-score of less than -2 SD to greater than or equal to -3 SD AND
  • No bilateral pitting edema

Summary Admission Criteria of Acute malnutrition cases:

Food Appetite Test: What is it?

  • Food appetite test is a process of analyzing or testing the appetite of the child in order to identify the hidden complications related to malnutrition.
  • This test is done for severely acutely malnourished children before starting their treatment
  • It is an easy but must necessary step to identify medical complication in a child
  • It is done by using Ready to Use Therapeutic Food (RUTF)
  • Any child who passes appetite test is considered to be one step closer to be free from medical complications while the child who fails the appetite test is considered to have medical complication
  • To pass the appetite test: A child should be able to eat at least 1/4th of a packet of RUTF within an hour
  • If the child is able to finish at least 1/4th of RUTF, then he/she will pass the appetite test while if he/she is not able to finish at least 1/4th of RUTF, then he/she will fail the test

Decision for admitting in OTC or referral to ITC:

After appetite test, health worker should make following decisions:

  • Give counselling and provide Ready to Use Supplementary Food (if available) for MAM children with no medical complication,
  • For MAM children with medical complication or no food appetite, treat according to CB-IMNCI protocol
  • For SAM children with no medical complication, treat in OTC
  • For SAM children with medical complication or no food appetite, treat the child in Inpatient Therapeutic Centre (ITC)/Stabilization Center (SC)

Whom To Admit in OTC?

  • SAM cases (MUAC <115 mm or WHZ <-3 S.D or edema)

AND

  • No medical complication and
  • Good appetite

Additionally, these children should also be admitted to OTC:

  • Children who are referred from ITC to OTC for regular check up
  • Children who left the treatment earlier and came back now
  • Special cases (children more than 59 months age who are very thin or have edema, children with HIV and AIDS)

Whom NOT TO Admit in OTC?

  • Children less than 6 months or more than 59 months of age
  • Children with medical complication/s
  • Children with no/poor food appetite
  • Children with Marasmic-Kwashiorkor (edema with MUAC < 115 mm or and WHZ < -3 S.D)
  • Children with Moderate Acute Malnutrition

What do we understand by Medical Complication?

Presence of any one/more of the following condition is referred to as medical complication:

  • Edema +++
  • Marasmic-Kwashiorkor
  • No food appetite/fail the food appetite test
  • High fever (>38.5 degree celsius)
  • Hypoglycemia
  • Hypothermia (35.5 to 36.5 degree celsius)
  • Severe anemia
  • Superficial infection
  • Severe dehydration
  • Congestive heart failure
  • Vomits everything
  • Having convulsions/Loss of consciousness
  • Jaundice
  • Not able to drink or breastfeed and/or does not eat

Criteria for referring a child from ITC to OTC:

  • Medical complications should be treated and absent
  • The child should have good appetite (checked by using RUTF)

Who are admitted to ITC?

  • SAM children of 6-59 months age who have medical complication/s
  • Children less than 6 months age who:
  • Have Kwashiorkor
  • Are severely underweight (less than 3 kgs)
  • Cannot breastfed/did not get mother milk to feed and living in a vulnerable environment
  • Children with poor food appetite
  • Severe Nutritional Edema +++ cases
  • Marasmic Kwashiorkor cases
  • SAM with medical complication
  • HIV positive child
  • Any other cases which requires referral

 

References and for more information:

https://www.scribd.com/document/8368324/Integrated-Management-of-Acute-Malnutrition

http://sustainuganda.org/sites/sustainuganda.org/files/GL_Integrated%20Management%20of%20Acute%20Malnutrition%20(2010).pdf

http://www.who.int/nutrition/topics/malnutrition/en/

https://www.unicef.org/media/files/Community_Based__Management_of_Severe_Acute_Malnutrition.pdf

http://www.slideserve.com/neylan/integrated-management-of-acute-malnutrition

http://www.kznhealth.gov.za/family/MCWH/KZN-IMAM-Guidelines.pdf

http://www.southsudanmedicaljournal.com/clinical-guidance/interim-guidelines-on-the-integrated-management-of-severe-acute-malnutrition.html

http://www.ennonline.net/fex/43/acute

https://ugandarefugees.org/wp-content/uploads/IMAM_Guidelines-for-Uganda-Jan-2016-FINAL-LORES2-2.pdf

https://www.impactpool.org/jobs/287656

https://www.unicef.org/evaldatabase/index_69863.html

http://motherchildnutrition.org/malnutrition-management/integrated-management/index.html

http://www.infocenter.nercha.org.sz/sites/default/files/AcuteMalnutritionGuide.pdf

http://www.aada.org.af/integrated-management-acute-malnutrition

http://www.who.int/elena/titles/full_recommendations/sam_management/en/

https://www.humanitarianresponse.info/system/files/documents/files/Guidelines%20for%20Management%20of%20Acute%20Malnutrition%20through%20Community-based%20Therapeutic%20Care%20%28CTC%29.pdf

http://www.who.int/nutrition/topics/malnutrition/en/

http://www.ennonline.net/fex/43/integrated

https://www.unicef.org/eapro/VA2016-21_Consultant_-_Revision_and_Update_of_Integrated_Management_of_Acute_Malnutrition_Guidelines_.pdf

https://www.humanitarianresponse.info/en/operations/nepal/document/nepal-integrated-management-acute-malnutrition-imam-guidelines

 

 

About Kusum Wagle 213 Articles
Hello and greetings everyone! I am Kusum Wagle, MPH, WHO-TDR Scholar, BRAC James P. Grant School of Public Health, Bangladesh. I have gained profound experiences in public health sector under different thematic areas of health, nutrition, sexual and reproductive health, maternal and newborn health, research etc., targeting diverse audience of different age groups. I have performed diverse roles ranging from lecturer in the public health department of colleges, nutrition coordinator, research coordinator and consultant, in different programs, projects and academic institutions of Nepal. I also hold immense experience in working closely and persistently with government organizations, non-government organizations, UN agencies, CSOs and other stakeholders at the national and sub-national level. I have successfully led and coordinated different projects involving multi-sector participation and engagement. Moreover, I am also regularly involved in the development of different national health related programs and its guidelines.