MAMI – An Innovative Approach to Infant Nutrition Pioneered by GOAL

Responding to the problem of acute malnutrition

In 2016, GOAL became the first International NGO to trial an innovative new infant nutrition programme in two refugee camps in Gambella, Ethiopia. The approach specifically targeted infants from birth up to 6 months of age. The new initiative, called the community ‘Management of At-Risk Mothers and Infants’ (MAMI), was in response to the large number of vulnerable mothers and infants who were at risk of malnutrition after fleeing war-torn South Sudan and becoming displaced in the Terkidi and Kule camps.

MUAC-MAMI tape at use in Kule Refugee camp, Gambella, Ethiopia.

Infants from birth to 6 months of age are considered to be a widely neglected demographic in low-income countries. Historically, there have been assumptions that all women could and should breastfeed infants within this age bracket. However, given that the UN estimate that only around 40% of the global population exclusively breastfeed until 6 months, it is estimated that approximately 8.5 million infants between birth and 6 months are suffering from acute malnutrition.

The nutrition team at GOAL has integrated the MAMI approach into its nutrition programme and now works with a team of experts to help pioneer the project. MAMI, unlike many other public health programs, brings together both a preventative and curative approach to infant malnutrition. With a focus on support and rehabilitation, MAMI uses counselling and clinical support for mothers/carers to care for small infants at risk of malnutrition. Traditionally, screening is undertaken by community outreach agents using simple referral criteria and thorough monthly screening by counsellors at various nutrition centres.  Since May 2019, GOAL have been collecting digital data of families who remained resident in the camps –  a cure rate of 71% was observed. Some children were referred to other nutrition support services upon reaching 6 months of age and a small proportion were referred to inpatient settings, who required more intensive clinical support. No deaths were recorded.

The MAMI-MUAC Screening Tool

MAMI-MUAC tape design: Enumerated (top) for use with trained health workers and non-enumerated (bottom) for use in the community

As part of the organisation’s work in this area, and in order to improve early case identification of at risk infant-mother pairs, GOAL’s nutrition team has recently developed an innovative new concept  – the ‘MAMI-MUAC’ screening tool. The design sees GOAL adapt the standard MUAC (mid upper arm circumference)  tape for older children between 6 and 59 months of age and pregnant-lactating women and print risk markers for children between 0-<6 months on the revers.  The easy-to-use new tool aims to support quick identification of at-risk infants under six months by both community health workers and, most importantly, by families themselves. GOAL is trialing two MUAC thresholds and it is hoped that this will support other research to determine appropriate cut-off points for this age group. The MAMI-MUAC concept was designed by GOAL’s nutrition technical team, along with the support of consultant Mark Mayatt of Brixton Health. GOAL expects to trial the MAMI-MUAC tape for a period of 18 months in Ethiopia.

The MAMI approach was initially developed by the Emergency Nutrition Network (ENN) along with the London School of Hygiene and Tropical Medicine (LSHTM) with support from a number of organisations involved in the MAMI Special Interest Group. More detailed information on GOAL’s MAMI approach  can be found here.