This document summarizes a nutrition program in Bangladesh that aims to address acute malnutrition among vulnerable populations affected by water logging. The program will use a Community-based Management of Acute Malnutrition (CMAM) approach across 18 unions in 4 upazilas. It expects to screen 2,500 children aged 6-59 months, identifying around 600 cases of severe acute malnutrition and 7,400 cases of moderate acute malnutrition. It will also screen 6,300 pregnant and lactating women for moderate acute malnutrition. The program will provide outpatient and inpatient treatment through OTP centers, stabilization centers, and MAM centers. It is being implemented by ACF and WFP through their local partner Shushilan. Progress to date

1. Address high acute malnutrition among vulnerable
populations affected by water logging
through CMAM prog.
Bangladesh
05 April 2012

2. Background & Context Analysis
 Prolonged water logging in south western districts of Satkhira,
Khulna and Jessore in July/August 2011, affected the
vulnerable population.
 WFP & ACF, with local partners, intervened with emergency
interventions, focusing FS/livelihood, WASH & small nutrition
surveillance to address their immediate needs
 A number of assessments and surveys (ACF’s nutrition
surveillance, nutrition survey, HKI, FS assessment WFP, FAO
and Shushilan, JNA for recovery) were carried in 2011, which
showed deteriorated nutrition situation.
 Findings from those surveys/assessments led to the
development of a nutrition programme to address acute
malnutrition.

3. Objective of the Programme:
Principal objective:
To reduce the risk of mortality and morbidity among the
most vulnerable population affected by water logging
Specific objectives:
 To reduce the risk of mortality and morbidity linked to
severe acute malnutrition among children under 5 years
old in areas affected by water logging
 To prevent the deterioration of nutrition status of children
(6-59) and maternal -Pregnant & Lactating Women (PLW)
nutritional status in the most affected areas

4. Target Areas: 18 Unions in 4 Upazilas
Upazilas
Tala Satkhira Sadar Dehhata Assasuni
Unions
Dhandia Bali Kulia Kadakati
Islam Kati Dhulihar Parulia
Jalalpur Labsa
Khalilnagar Satkhira Sadar
Khalishkali Jhaudanga
Khesra
Kamira
Nagarghata
Tala Sadar
Tentulia

5. Target beneficiaries: (6 – 59 months/PLW)
 Approximately, 2,500 children will be screened and among
them, about 600 children aged 6-59 months are expected to
be with Severe Acute Malnutrition (SAM)
 Complicated SAM and MAM cases will be referred to the
three Upazila Health Complex (UHCs) and the District
Hospital to receive inpatient treatment.
 All children aged 6-59 months with moderate acute
malnutrition (MAM) will be identified– expected number
7,400
 All PLW with moderate acute malnutrition (MAM) will be
identified– expected number 6,300

6. Main activities of the current project
Activity- 1
 Training and coaching of national staff of Shushilan and GoB health
structure staff-Community Clinic (CC) and Upazila Health Complex(UHC)
for the implementation of the CMAM approach, including detection and
treatment of MAM/SAM cases.
Activity- 2
 Community and center based screening for under five children and
pregnant and lactating mothers for acute malnutrition and referral for
appropriate treatment, depending on condition; community mobilization
and health/nutrition education
Activity- 3
 Setting up and running of Outpatient Therapeutic Programme(OTP),
Sterilisation Centre (SC) through partner and UHC; and of MAM centres
in CC
Activity- 4
 Progress monitoring and reporting

7. Programme Approach
Community-based Management of Acute Malnutrition (CMAM)
CMAM has four components:
 Community mobilization (for early detection & referral of the
malnourished, follow up at home, and prevention activities)
 Supplementary Feeding Program (SFP) to treat moderate acute
malnutrition (MAM) - WFP will phase out from blanket feeding
programme and phase into TSFP.
 Outpatient Therapeutic Program (OTP) to treat severe acute
malnutrition without medical complications
 Inpatient care or Stabilization Centre (SC) to treat severe acute
malnutrition with medical complications through Upazila Health
Complex.

8. Why Choose CMAM approach?
CMAM approach is chosen as it is recognised by WFP and other
UN agencies as the best practice to treat acute malnutrition.
 Increased coverage of program
 Increased early detection of malnourished for
treatment
 Reduced risk of cross infection
 Decreased default rates: caregivers continue
economic and domestic activities while their children
undergo treatment, or other CMAM activities
 High cure rate and low death rate
 Sustainable, if possible to integrate to national health
system
 Increased communities’ ownership of the program

9. Implementation strategy
 ACF & WFP work through National NGO, Shushilan
 Shushilan will be in charge of screening children and refer
them to the appropriate nutrition programme according to
their MUAC measurements.
 ACF will take over the responsibility to assist and train
Shushilan staff in the CMAM approach for treatment of
acute malnutrition in children under 5 as well as of PLW in
collaboration with WFP.
 With the approval of CS office, Shushilan and ACF will
include some of the local health facility staff (CC and FW
and health centres) into the capacity building approach as
well as the staff of the UHCs in the four Upazilas where
children suffering from SAM with complications will need
to receive inpatient treatment.

10. Progress to date
 Funding has been secured from ECHO
 Some local Authorities has been informed of the 2nd phase of the
program including CMAM;
 Blanket Feeding for 6 – 59 months and PLW on-going (5,200 of
17,500)
 Draft FLA, including budget, prepared and shared with Shushilan;
 Shushilan in the process of recruiting staff (nutritionist, nurses
etc.)
 First CMAM ToT training being conducted this week
 Preparatory meeting held for progressive phasing out of Blanket
feeding to targeted feeding (CMAM)
 ACF perusing NGOB for FD6 approval, while processing to get
specific nutritious food to treat SAM cases.

11. Thank you All