Managing Acute Malnutrition

The Challenge

  • Each year, an estimated 6.6 million children die before their fifth birthday. Poor nutrition is implicated in
    nearly half of these deaths.
    Each year, an estimated 6.6 million children die before their fifth birthday. Poor nutrition is implicated in nearly half of these deaths.
  • In emergency settings, malnutrition is often treated in temporary feeding centers built and managed by outside organizations that attempted to treat all cases of acute malnutrition irrespective of severity.
  • This approach causes overcrowded centers where infections spread rapidly.

HKI Solutions

In our efforts to prevent and treat malnutrition, Helen Keller International applied Valid International’s approach of Community-based Management of Acute Malnutrition (CMAM) - which enables communities and lower level health facilities to treat the vast majority of cases and reserves in-patient care for only those with critical complications – and improved upon it by building the capacity to deliver this approach within existing government and community structures.

  • CMAM has been integrated into existing child survival and malnutrition prevention programs, providing a holistic approach to managing acute malnutrition. HKI’s approach uses existing community structures, trains community members to identify and handle treatable cases of acute malnutrition (instead of relying on externally managed programs), and minimizes the time most afflicted mothers and children must be kept in the centers, away from home.
  • HKI also integrates with treatment the Essential Nutrition Actions framework to guide the development and dissemination of preventive practices, such as optimal breastfeeding and complementary feeding.
  • Consistent with the CMAM approach, only cases of severe malnutrition that involve complications are kept in health centers or hospitals, while children with appetites receive outpatient care from caretakers who are provided with Ready-to-Use-Therapeutic Foods (RUTF), such as Plumpy’Nut®, as well as medication and instructions for in-home treatment of acute malnutrition.
    • Plumpy’Nut® and related RUTF products are nutrient-rich pastes that are specifically designed for the treatment of severe malnutrition. They are easy to store in the home with minimal risk of contamination, and can be fed to children directly from the foil package with no further preparation required.
  • By reducing the number of cases that are required to be treated at in-patient facilities, the likeliness of infection and the financial and social burden to most families also reduces.


HKI helped government partners in Burkina Faso, MaliNiger and Senegal to develop national protocols for managing acute malnutrition, thus strengthening the health system’s self-sufficiency in managing treatment efforts in each country. HKI is currently developing a web-based database to improve HKI’s monitoring and reporting of health center results.

For the future, Helen Keller International is focusing on ensuring that knowledge and skills of managing acute malnutrition is reinforced and retained in the health system, and conducting research into how to improve the dietary contents of supplementary food for moderately malnourished children. In addition, we are identifying more effective channels for treating or preventing malnutrition as early as possible.