Community Management of Acute Malnutrition

Hunger kills more people every year than AIDS, malaria, and tuberculosis combined. Undernutrition causes 45 percent of all deaths of children under the age of five, leading to more than three million deaths per year. Community Management of Acute Malnutrition (CMAM) is an approach that aims to reach the most vulnerable and acutely affected children in an effort to save lives and restore good health and nutrition.

Treating malnutrition used to require that caregivers, usually mothers, transport their already fragile children to places where help was available. Sometimes this involved long journeys, and almost always it involved checking into inpatient treatment centers for prolonged periods.

This compounded the impact of malnutrition as caregivers were forced to leave behind family, work, and other commitments.

A radical, innovative solution

The traditional approach was time-consuming, unwieldy, uncomfortable, and ultimately not as effective as it could be. It was a seemingly intractable problem that required a radical, innovative solution. In 2002, a partnership between Concern Worldwide and Dr. Steve Collins, Director of Valid International, set in motion a process that generated just such a game-changing solution, first known as Community-based Therapeutic Care, CTC, better known today as CMAM .

CMAM brings critical malnutrition treatment directly to those who need it most, administered locally by community members.

This works by training volunteers from the community to look for the symptoms of undernutrition before they become life-threatening. Children at risk are treated in their own homes with vitamin-enriched therapeutic food (RUTF) and monitored through bi-weekly home visits from health staff.

By 2004, after a successful pilot in Malawi yielded excellent results in treatment outcomes, coverage, and community acceptance, CMAM was ready to expand.  With assistance from UNICEF and funding from USAID, we published several field guides and training modules to facilitate replicating the program.

The approach goes global

In order to save lives on a greater scale, Concern and Valid shared our knowledge with other agencies.  Working closely with UNICEF and with funding from USAID, we published a CTC Field Manual and modules for practical training on CTC for implementers. In 2007, the program was named an international best practice by the United Nations.

Concern now has CMAM programs in 10 countries, and on a global level, the approach is being implemented to varying degrees by Ministries of Health in more than 50 countries, and reaching more than 70 percent of malnourished children.


View One in Six, a documentary telling the story of Concern’s pioneering work with CTC: