Applying the Community-Based Management of Acute Malnutrition (CMAM) Model in Preparing Communities to Respond to Pandemic Influenza Outbreak

The Community-Based Management of Acute Malnutrition (CMAM), also known as Community-Based Therapeutic Care (CTC), has been used to manage severe acute malnutrition following humanitarian crises since the late 1990s, when it was realized that using the traditional therapeutic feeding center model of inpatient care was impractical and ineffective. The CMAM approach entails prioritizing care for the majority of the acutely ill in their homes, and providing inpatient care for the few extreme cases. Community mobilization techniques are used to engage affected populations and maximize coverage, and whenever possible, programs build on local capacity and existing structures and systems. This presentation will address how to apply the CMAM approach in preparing for an outbreak of pandemic influenza, including educating communities in advance of an outbreak so they know services will be available, and training community health workers, who will likely be the main sources of information on symptoms, preventive behaviors, home-based care and other interventions necessary to control the spread of a pandemic virus. The presentation provide a systematic review of the Community-based Therapeutic Care Field Manual developed by Valid International, and outline how CTC program components can be applied to a pandemic outbreak on the community level, including steps to specifically address severe acute malnutrition caused or exacerbated by the pandemic. The components to be addressed include: 1) maximum coverage and access – making services accessible to the highest possible proportion of a population in need; 2) timeliness – beginning case-finding and treatment before the prevalence escalates and additional medical complications occur; 3) outpatient care protocols that are intentionally easy to teach to community health care workers or others likely be called to help in the situation of a pandemic, including animal health workers, school teachers, village leaders/elders, and midwives; 4) care for as long as it is needed by building local capacity and integrating care within existing structures and health services; and 5) focus on community engagement, understanding and participation, as opposed to health extension services designed from the perspective of health care providers that often have difficulty fostering sufficient community acceptance. Finally, the presentation will suggest ways that international and national NGOs and other agencies can participate in this process.