Course Overview

Community-Based Management of Acute Malnutrition (CMAM)

⏱ Duration: 6 Weeks | 16 Contact Hours | Mode: Blended learning (online and in-person workshops)

Instructor

• Syeda Sumaiya Nasrin: Manager- Knowledge Management and Donor Reporting, Health and Nutrition, Humanitarian Crisis Management Programme (HCMP).
• Lipi Rani Mondal: Lecturer (Senior-scale), Department of Nutrition and Food Engineering, Daffodil International University.

Course Description

The purpose of CMAM is to maximize coverage and access to life-saving treatment for acute malnutrition by providing decentralized, home-based care before medical complications develop.

Evidence of Demand

• The demand for a specialized CMAM course in Bangladesh is driven by critical gaps in public health infrastructure, high malnutrition burdens, and the urgent need for trained community-level responders.
• Severe Burden of Malnutrition: Bangladesh records a maternal mortality ratio of 173 per 100,000 live births and an infant mortality rate of 28 per 1,000 live births (World Bank, 2021). Frontline training is time-sensitive, as the first 1,000 days of an infant's life are vital for long-term developmental outcomes (WHO, 2021).
• Socioeconomic Barriers: Decentralizing acute wasting treatment to villages helps bypass economic barriers, as approximately 24% of the population survives below the poverty line (BBS, 2020), making hospital journeys financially impossible for many. Community strategies also reduce urban health system pressures and transmission risks.
• Evidence-Based Protocols: Standardized, community-oriented protocols significantly drive down infant wasting mortality, and systematic clinical evaluations (like MUAC metrics) ensure cases are tracked uniformly to prevent relapse.
• Empowering Frontline Infrastructure: Active social mobilization and dedicated field worker tracking drastically optimize longitudinal patient adherence.

Course Objectives

This course aims to:

• Early Detection: Screen children early using Mid-Upper Arm Circumference (MUAC).
• Outpatient Care: Treat severe acute malnutrition (SAM) at home using RUTF.
• Inpatient Stabilization: Provide 24-hour clinical care for complicated malnutrition cases.
• Prevention: Manage moderate acute malnutrition (MAM) to prevent severe wasting.
• Integration: Embed malnutrition treatment into existing primary healthcare systems.

Course Content & Class Plan (Modules)

• Week 1: Foundations of Acute Malnutrition & The CMAM Framework: Global and national burdens; differentiating wasting, stunting, and underweight; shifting to decentralized CMAM.
• Week 2: Community Mobilization & Active Case-Finding: Strategies for community engagement; barrier identification; stakeholder mapping and trust-building.
• Week 3: Outpatient Therapeutic Program (OTP) Management: Admission/discharge criteria for SAM without complications; routine medical protocols.
• Week 4: Inpatient Care & Management of Complicated SAM: Stabilization Center (SC) criteria; treating hypoglycemia, hypothermia, and dehydration.
• Week 5: Managing Moderate Acute Malnutrition (MAM) & IYCF: Targeted SFP protocols; Infant and Young Child Feeding (IYCF) practices; maternal nutrition/mental health.
• Week 6: M&E, Reporting, and Course Wrap-Up: Monitoring indicators (cure, default, death rates); HMIS data integration.

Practical & Field Work (60% of Course)

• Navigating national integrated management guidelines and CMAM core components.
• Hands-on practice using MUAC tapes, assessing bilateral pitting edema, and role-playing referral conversations.
• Conducting Ready-to-Use Therapeutic Food (RUTF) appetite tests and filling OTP treatment cards.
• Calculating and preparing therapeutic milks (F-75 and F-100) and drafting feeding schedules.
• Counseling caregivers on nutrition using local foods and designing IYCF-nutrition sessions.
• Compiling monthly facility nutrition reports and supply chain forecasting for RUTF.

Learning Outcomes

After completing the course, participants will be able to:

• Identify and classify acute malnutrition forms (SAM, MAM, stunting) using standard WHO anthropometric indicators.
• Perform accurate physical measurements (MUAC taping, grading pitting edema) and standard appetite tests.
• Prescribe correct routine medical therapies and formulate F-75/F-100 feeding protocols.
• Execute proper triage, referral, and discharge decisions.
• Design localized mobilization strategies and counsel mothers on IYCF and postpartum mental well-being.
• Maintain accurate facility records, calculate program indicators, and forecast supply-chain requirements.

Target Audience & Requirements

Target Audience:

• Community health workers supporting mothers and infants.
• Healthcare professionals (nurses, midwives) focused on maternal/child health.
• Nutritionists, dietitians, NGO staff in underserved communities, public health students, and policy makers.
• Class Size: Maximum 25 participants.

Entry Requirements:

• A background in health, nutrition, or social sciences (e.g., diploma or degree).
• Relevant work experience in community health, maternal and child health, or nutrition.
• Basic understanding of nutrition and health concepts.
• Minimum Age: The lowest age to enroll is 20 years.

Career Pathways

• Roles as Community Health Workers and management positions with UNICEF, WFP, BRAC, ACF.
• Specialized training at icddr,b.
• Policy advocacy with the Ministry of Health.
• Research contributions at icddr,b.

Tools & Resources

• MUAC measuring tapes and infant weighing scales.
• Sample growth charts (W/A and W/L).
• Case scenarios (printed descriptions of hypothetical infants).
• Assessment checklist and access to nutritional assessment tools.
• Online learning platform and instructional materials (readings, case studies).

Assessment Criteria

• Assignments, Quizzes, Group/Community Project.
• Week 1 online knowledge check.
• Case study review on program defaulting.
• Practical OSCE (Objective Structured Clinical Examination).
• Midterm exam on inpatient protocols and final comprehensive exam with field logbook submission.

Certification

Successful completion of assessments, practical OSCEs, exams, and field logbook submissions will result in the awarding of a micro-credential certificate.

Financial Information

• Tentative Course Fee: 2,500 BDT.