Key Messages of IMAM (Integrated Management of Acute Malnutrition) Program

IMAM stands for Integrated Management of Acute Malnutrition.
It is an integrated program to fight back against acute malnutrition.
It is a nutritional program designed especially for children of 6-59 months of age and is a very important concept for management of malnutrition.
Although there are lot of technical knowledge and skills required to implement this program effectively, in this article we will only guide you throughout the key messages and knowledge related to it. This will certainly help you understand the crux of the program and at the same time providing you with simple yet essential information.

Principles of IMAM Program:

IMAM program is based on four key principles:

Medical care and treatment of cases as per the requirement
Treatment of Severe Acute Malnutrition (SAM) cases without complications in OTC
Treatment of SAM cases with complications in Inpatient Therapeutic Care (ITC). It is also known as Stabilization Center (SC).

Components of IMAM Program:

Additionally, IMAM program has four components. They are:

Community Outreach/mobilization
Outpatient treatment of SAM without complication i.e. treatment of SAM children under supervision of health worker but not admitting in the health facility
In-patient treatment of SAM with complication i.e. treatment of SAM patient by admitting in the health facility (hospital/stabilization center)
Management of Moderate Acute Malnutrition

Target group of IMAM program:

6-59 months age children
Children above 59 months (for special cases of HIV/AIDS, Severe acute malnutrition and edema)

Assessment of Acute Malnutrition:

Acute Malnutrition in a child can be assessed/identified by:

Decision making for Severe Acute Malnourished (SAM) and Moderate Acute Malnourished (MAM) child:

A child is SAM case if he/she meet any of the following criteria:

A child is MAM case if he/she meet any of the following criteria:

MUAC measurement of greater than or equal to 115mm to less than 125mm OR
Weight for height Z-score of less than -2 SD to greater than or equal to -3 SD AND
No bilateral pitting edema

Summary Admission Criteria of Acute malnutrition cases:

Food Appetite Test: What is it?

Food appetite test is a process of analyzing or testing the appetite of the child in order to identify the hidden complications related to malnutrition.
This test is done for severely acutely malnourished children before starting their treatment
It is an easy but must necessary step to identify medical complication in a child
It is done by using Ready to Use Therapeutic Food (RUTF)
Any child who passes appetite test is considered to be one step closer to be free from medical complications while the child who fails the appetite test is considered to have medical complication
To pass the appetite test: A child should be able to eat at least 1/4^th of a packet of RUTF within an hour
If the child is able to finish at least 1/4^th of RUTF, then he/she will pass the appetite test while if he/she is not able to finish at least 1/4^th of RUTF, then he/she will fail the test

Decision for admitting in OTC or referral to ITC:

After appetite test, health worker should make following decisions:

Give counselling and provide Ready to Use Supplementary Food (if available) for MAM children with no medical complication,
For MAM children with medical complication or no food appetite, treat according to CB-IMNCI protocol
For SAM children with no medical complication, treat in OTC
For SAM children with medical complication or no food appetite, treat the child in Inpatient Therapeutic Centre (ITC)/Stabilization Center (SC)

Whom To Admit in OTC?

AND

Additionally, these children should also be admitted to OTC:

Children who are referred from ITC to OTC for regular check up
Children who left the treatment earlier and came back now
Special cases (children more than 59 months age who are very thin or have edema, children with HIV and AIDS)

Whom NOT TO Admit in OTC?

Children less than 6 months or more than 59 months of age
Children with medical complication/s
Children with no/poor food appetite
Children with Marasmic-Kwashiorkor (edema with MUAC < 115 mm or and WHZ < -3 S.D)
Children with Moderate Acute Malnutrition

What do we understand by Medical Complication?

Presence of any one/more of the following condition is referred to as medical complication:

Criteria for referring a child from ITC to OTC:

Who are admitted to ITC?

SAM children of 6-59 months age who have medical complication/s
Children less than 6 months age who:
Have Kwashiorkor
Are severely underweight (less than 3 kgs)
Cannot breastfed/did not get mother milk to feed and living in a vulnerable environment
Children with poor food appetite
Severe Nutritional Edema +++ cases
Marasmic Kwashiorkor cases
SAM with medical complication
HIV positive child
Any other cases which requires referral