Combined Approach for the

Treatment of Wasting in
Emergencies in Ethiopia
Program adaptation for
treatment of wasting

April, 2023
Foreword

In Ethiopia, noteworthy progress has been made in improving and scaling up the treatment of
acute malnutrition in the past decades. the management of Severe Acute Malnutrition (SAM) has
been included in the National Nutrition Plan since 2008 and has been successfully scaled up and
integrated as part of routine health program delivery within the Health Extension Package (HEP).
Further, the current guideline for the management of acute malnutrition endorsed by the GoE in
2019 includes both MAM and SAM in the same document, which was treated separately before,
whereby the delivery of MAM and SAM services are integrated at the facility level ensuring the
continuum of care.

A simplified and combined approach is intended to simplify and unify the treatment of wasting
(uncomplicated severe and moderate acute malnutrition) for children ages 6-59 months in an
emergency context into one protocol that aims to improve the coverage, quality, continuity of
care and cost-effectiveness of acute malnutrition treatment. These simplifications are proposed
upon the standard protocol management of acute malnutrition which includes MUAC and
edema-based admission and discharge criteria, treatment with a solitary product, reduced
dosage, reduced follow-up visits for stable children, and expanded admission criteria. The
simplification allows for more efficient triage and patient flow reducing the workload and burden
on staff and caregivers.

The Ministry of Health adopted and developed this guideline, in addition to the existing standard
acute malnutrition management guideline; aiming at providing standardized guidance on how to
apply the proposed simplifications to the management of uncomplicated SAM and MAM and the
contexts for which these will be applied. Evidence supports that simplifying and streamlining the
management of acute malnutrition in such situations will improve both coverage and quality of
care and decreases mortality, particularly in emergency contexts where there is an extremely
high caseload and resources are limited differing contexts, including in acute and chronic
humanitarian emergencies.

I would like to accentuate that, implementers of this guideline including RHBs, UN agencies,
INGO’s, and others gain approval from MoH at the national level before the application of these
approaches when the need arises. During the implementation of one or more of the combinations
of the simplified approaches, implementing partners need to closely monitor progress and
evaluate the implementation to decide on how and when to deactivate the approaches and
transition to the standard routine guideline for the management of acute malnutrition.
Meanwhile, the guideline will also be piloted through rigorous research studies of various
contexts to generate evidence for supporting the simplified and combined protocols and on
future decisions regarding the integration of the approaches into the national guideline for the
management acute malnutrition management protocols.

H.E. Dr. Lia Tadesse

Minister of Health
Federal Democratic Republic of Ethiopia

i treatment of wasting in emergencies in Ethiopia

Acknowledgment
This simplified and combined approaches guideline is prepared for the adaption of wasting
treatment in emergency context. In the emergency settings, the food shortage, unavailability of
food and access to basic services will lead to acute food shortage and acute malnutrition.
Therefore, implementing the standard treatment protocol may be is difficult to reach more
children and save lives in an emergency setting. These approaches will be used to address the
magnitude in an emergency setting.

The FMOH sincerely acknowledges the financial and technical contribution of UNICEF, WFP, WHO,
ENCU, SCI, ACF

The Ministry of Health greatly appreciates the following individuals who supported the preparation
of the simplified and combined approach for the wasting Management in Ethiopia in 2021, extend
its gratitude to the following experts and organizations who have made major contributions to the
development of this guideline.

S.
Name Responsibility Organization
No

1. Hiwot Darsene Lead Executive Officer of NCO MoH

2. Frezer Abebe National Nutrition expert, CMAM lead MoH

3. Gelila Zewdu Nutrition Specialist MoH/UNICEF

4. Dr. Belaynesh Yifru Nutrition Specialist MoH

5. Miraf Tesfaye MoH

6. Shibru Kalbessa MoH

7. Tarekegn Negesse Nutrition M & E specialist MoH

8. Dr. Betty Lanyero Technical officer, Nutrition WHO

ENCU Team Leader Nutrition Cluster

9. Cecile Basique ENCU
Coordinator

10. Wondayferam Gemeda ENCU\Deputy Nutrition Cluster Coordinator ENCU

11. Banchiliyew Getahun Nutrition Specialist UNICEF

12. Rashid Abdulai Nutrition Specialist UNICEF

ii treatment of wasting in emergencies in Ethiopia

 13. Nutrition Specialist UNICEF
UNICEF
14. Dr. Tewoldeberhan Daniel Nutrition Manager
ESARO
15. Mulu Gebremedhin IMAM National Consultant WFP

ABH
16. Shiferaw Fisseha Emergency Nutrition National Coordinator
PARTNERS

17. Mihret Teshome Nutrition Expert AAH

18. Muluneh Girma Head of Department (HoD)-Nutrition AAH

and Health
19. Anley Haile Head of Integrated Programs GOAL

Hiwot Darsene
Lead Executive Officer of Nutrition Coordination Office, MOH

iii
Scope of the guide

þǠơɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎnjʠǫƎơȍǫȥơljȶɭʋǠơȟŔȥŔnjơȟơȥʋȶljŔƃʠʋơȟŔȍȥʠʋɭǫʋǫȶȥˁǫȍȍȶȥȍˊŹơ
ŔɢɢȍǫơƎǫȥɽɢơƃǫ˪ƃƃȶȥʋơˉʋɽˁǠơɭơʋǠơɭơǫɽŔɽǫnjȥǫ˪ƃŔȥʋǫȥƃɭơŔɽơǫȥɭŔʋơɽȶljŔƃʠʋơȟŔȍȥʠʋɭǫʋǫȶȥ࡫Ŕ
ǠǫnjǠŹʠɭƎơȥȶȥƃǠǫȍƎȟȶɭʋŔȍǫʋˊƎʠơʋȶơȟơɭnjơȥƃǫơɽɽʠƃǠŔɽƃȶȥ˫ǫƃʋ࡫ƎɭȶʠnjǠʋ࡫ȶɭȶʋǠơɭɽŹơˊȶȥƎ
the capacity of the routine system. This is particularly so when barriers to providing the full
continuum of care for acutely malnourished children in such situations, such as supply or capacity
constraints, or in contexts with a high caseload and lack of resources or system failure faced,
which can be addressed through these temporary measures.

þǠơɽơ ȟȶƎǫ˪ƃŔʋǫȶȥɽ ʋȶ ʋǠơ ȟŔȥŔnjơȟơȥʋ ȶlj Ŕƃʠʋơ ȟŔȍȥʠʋɭǫʋǫȶȥ ɢɭȶʽǫƎơ ʋơȟɢȶɭŔɭˊ ȶɢʋǫȶȥɽ ljȶɭ
ʋɭơŔʋǫȥnjˁŔɽʋǫȥnjǫȥʋǠơŔŹɽơȥƃơȶljþòbáŔȥƎࡸȶɭ¶þáŔȥƎŔɭơȟơŔȥʋljȶɭŔƃʠʋơƃɭǫɽơɽȶȥȍˊࢎɭŔɢǫƎ
ȶȥɽơʋ ȶɭ ɢɭȶʋɭŔƃʋơƎ ƃɭǫɽǫɽ ˁǫʋǠ Ŕ ɽǫnjȥǫ˪ƃŔȥʋ ʠȥơˉɢơƃʋơƎ ɽɢǫȇơ ǫȥ ƃŔɽơȍȶŔƎ࢏ࡲ þǠơ njʠǫƎơȍǫȥơ ˁǫȍȍ
be applied through integration with primary and secondary healthcare or different platform to
address the needs of a large number of children with malnutrition in an acute humanitarian crisis
ŔȥƎŔɭơŔɽˁǫʋǠȍǫȟǫʋơƎŔƃƃơɽɽljȶɭŹȶʋǠɢɭȶʽǫƎơɭɽŔȥƎŹơȥơ˪ƃǫŔɭǫơɽࡲ

The application of the guideline will be time-bound where there will be shifting to the routine
guideline once the situation is over and case management can be managed with the routine
health system.

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ iv
Abbreviations and acronym

AM Acute malnutrition

CHV Community Health Volunteer

CHW Community Health worker

CMAM Community-based Management of Acute Malnutrition

EDHS Ethiopia Demographic Health Survey

GAM Global Acute Malnutrition

GAP eȍȶŹŔȍƃʋǫȶȥáȍŔȥ

HEW’s Health Extension Workers

MAM Moderate Acute Malnutrition

MDHS Mini Demographic Health Survey

MUAC Mid upper Arm Circumference

OTP ¶ʠʋɢŔʋǫơȥʋþǠơɭŔɢơʠʋǫƃljơơƎǫȥnjáɭȶnjɭŔȟȟơ

RUTF Ready to Use Therapeutic Food

SAM- Severe Acute Malnutrition

SNF Specialized Nutritious Foods

TFSP þŔɭnjơʋơƎòʠɢɢȍơȟơȥʋŔɭˊbơơƎǫȥnjáɭȶnjɭŔȟ

UNICEF United Nations International Children’s Fund

WHO World Health Organization

WoHo ĭȶɭơƎŔqơŔȍʋǠȶlj˪ƃơ

ZHD Zonal Health Department

v eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
Table of Contents

Foreword i

Acknowledgment iii

Scope of the guide iv

Abbreviations and acronym v

Introduction 1

Rationale 2

Objectives 6

1. Admission and discharge based on MUAC or edema 7

2. Family MUAC 7

Table 3: Admission and Discharge criteria 7

4. Use Community Health volunteer-to treat wasting 8

5. Reduce Frequency of Follow-up Visits 8

Table 4: RUTF Dosage 8

10

Table 6: Roles and responsibilities of stakeholders 10

Human resource, logistics and monitoring, and evaluation 13

References 19

Annexes 20

vi
Introduction

Globally 45.4 million children suffer from wasting and 149.2 million children suffer from stunting
(World Bank Group Joint Child Malnutrition Estimates). Malnutrition is a major public health
ɢɭȶŹȍơȟ ƃȶȥʋɭǫŹʠʋǫȥnj ʋȶ ʋǠơ ƎơŔʋǠɽ ȶlj ŔɢɢɭȶˉǫȟŔʋơȍˊ ʋǠɭơơ ȟǫȍȍǫȶȥ ƃǠǫȍƎɭơȥ ŔnjơƎ ʠȥƎơɭ ˪ʽơ
ˊơŔɭɽ ơŔƃǠ ˊơŔɭ ࢎࠀ࢏ࡲ -ȶȥ˫ǫƃʋ ŔȥƎ ʋǠơ ȶƃƃʠɭɭơȥƃơ ȶlj ɭơɢơŔʋơƎ ơȟơɭnjơȥƃǫơɽ ǫɽ Ŕ ȟŔǿȶɭ Ǝɭǫʽơɭ ȶlj
ŔƃʠʋơȟŔȍȥʠʋɭǫʋǫȶȥ࡫ɢŔɭʋǫƃʠȍŔɭȍˊǫȥljɭǫƃŔ࡫ˁǠơɭơƃȶʠȥʋɭǫơɽơˉɢơɭǫơȥƃǫȥnjɢɭȶʋɭŔƃʋơƎƃȶȥ˫ǫƃʋǠŔʽơ
ʠȥƎơɭȥȶʠɭǫɽǠȟơȥʋɭŔʋơɽʋˁǫƃơŔɽǠǫnjǠŔɽʋǠȶɽơȥȶʋŔljljơƃʋơƎŹˊƃȶȥ˫ǫƃʋࡲ¡ŔȍȥʠʋɭǫʋǫȶȥǫɽʋǠơȟȶɽʋ
common risk factor in child deaths and will continue to be a major public health concern as the
ˁȶɭȍƎơˉɢơɭǫơȥƃơɽƃȶȥ˫ǫƃʋɽŔȥƎơȟơɭnjơȥƃǫơɽƎʠơʋȶɢȶȍǫʋǫƃŔȍƃɭǫɽơɽ࡫ȟǫnjɭŔʋǫȶȥ࡫ƃȍǫȟŔʋơƃǠŔȥnjơ࡫
and other causes (2).

ƃƃȶɭƎǫȥnj ʋȶ ʋǠơ ȟǫȥǫ࢚F7qò ࠁ߿ࠀࠈ࡫ ŔŹȶʠʋ ࠆࡲࠆ ɢơɭƃơȥʋ ȶlj ƃǠǫȍƎɭơȥ ʠȥƎơɭ ˪ʽơ ˊơŔɭɽ ˁơɭơ ˁŔɽʋơƎ
and 21 percent are underweight (Mini EDHS 2019). Nationwide, admissions for severe wasting for
ʋǠơ ˪ɭɽʋ ǠŔȍlj ȶlj ࠁ߿ࠁࠀ ˁơɭơ ࠆ ɢơɭƃơȥʋ ǠǫnjǠơɭ ʋǠŔȥ ʋǠơ ɽŔȟơ ɢơɭǫȶƎ ʋǠơ ɢɭơʽǫȶʠɽ ˊơŔɭࡲ òǫȟǫȍŔɭȍˊ࡫
ŔƎȟǫɽɽǫȶȥɽljȶɭȟȶƎơɭŔʋơˁŔɽʋǫȥnjǫȥʋǠơ˪ɭɽʋǠŔȍljȶljࠁ߿ࠁࠀˁơɭơŔȍɽȶࠂ߿ɢơɭƃơȥʋǠǫnjǠơɭʋǠŔȥǫȥʋǠơ
same period in 2020. The worsening nutrition situation can be attributed to factors such as the
negative consequences of the Covid-19 pandemic, desert locust infestation, recurrent drought,
ƃȶȥ˫ǫƃʋɽ࡫ ǠǫnjǠ ljȶȶƎ ɢɭǫƃơɽ࡫ ŔȥƎ ƎǫɽɭʠɢʋơƎ ɭŔǫȥljŔȍȍ ɢŔʋʋơɭȥɽ Ŕȍȍ ȍơŔƎǫȥnj ʋȶ Ŕƃʠʋơ ljȶȶƎ ǫȥɽơƃʠɭǫʋˊ
(ENCU monthly synopsis – May 2021 data and other Nutrition-related information).

In Ethiopia, in the past decade, the Government has applied a two-pronged approach to address
ȟŔȍȥʠʋɭǫʋǫȶȥࡲ þǠơ ˪ɭɽʋ Ŕɽɢơƃʋ ȶlj ʋǠơ ŔɢɢɭȶŔƃǠ ljȶƃʠɽơɽ ȶȥ ǫȥƃɭơŔɽǫȥnj Ŕƃƃơɽɽ ŔȥƎ ŔʽŔǫȍŔŹǫȍǫʋˊ ȶlj
food through improved economic growth, better agricultural production systems with promotion
of good nutrition practices and prevention of malnutrition. The second aspect aims to strengthen
early warning systems and timely emergency response, including wide-scale delivery of services
for the management of acute malnutrition (3).

However, management of wasting during emergencies using the routine service remains low and,
ŔƎȶɢʋǫȥnjŔɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠȟŔˊƃȶȥʋɭǫŹʠʋơʋȶǫȥƃɭơŔɽǫȥnjŔƃƃơɽɽʋȶʋɭơŔʋȟơȥʋljȶɭŔȍȍˁŔɽʋơƎ
ʠȥƎơɭ࢚˪ʽơƃǠǫȍƎɭơȥࡲþǠơeȍȶŹŔȍ-ȶȟȟʠȥǫʋˊȶljɢɭŔƃʋǫƃơǠŔɽƎơ˪ȥơƎࢪòǫȟɢȍǫ˪ơƎɢɢɭȶŔƃǠơɽࢫŔɽʋǠơ
Ǝǫljljơɭơȥʋࢪɽǫȟɢȍǫ˪ƃŔʋǫȶȥɽʋȶʋǠơơˉǫɽʋǫȥnjȥŔʋǫȶȥŔȍŔȥƎnjȍȶŹŔȍɢɭȶʋȶƃȶȍɽljȶɭʋǠơʋɭơŔʋȟơȥʋȶljƃǠǫȍƎ
ˁŔɽʋǫȥnjࢫࡲþǠǫɽɽǫȟɢȍǫ˪ƃŔʋǫȶȥǫɽƎȶȥơʋȶǫȟɢɭȶʽơơljljơƃʋǫʽơȥơɽɽ࡫ɩʠŔȍǫʋˊ࡫ŔȥƎƃȶʽơɭŔnjơ࡫ŔȥƎɭơƎʠƃơ
the costs of caring for children with uncomplicated wasting, mostly in resource constrained.
¡ȶɽʋ ȶlj ʋǠơ ɽʋʠƎǫơɽ ȶȥ ʋǠơ ɽǫȟɢȍǫ˪ơƎ ŔɢɢɭȶŔƃǠơɽ ǠŔʽơ Źơơȥ Ǝȶȥơ ǫȥ ȥȶȥ࢚ơȟơɭnjơȥƃˊ ɽơʋʋǫȥnjɽࡲ
However, these strategies can also be useful in emergency contexts where standard protocol
may be impracticable due to hampered coverage or compromised quality of care. Adopting these
approaches may ensure better access to wasting treatment services and mitigate against potential
excess mortality due to the emergencies.

1 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
Rationale

During emergencies, health facilities’ functionality will be affected, the health workforce and
the health system will be challenged, commodity availability for the service provision will be
compromised and resource limitations due to competing priorities will be faced. Moreover, an
emergency condition by itself is a very demanding situation that will incur an intensive investment
when planning an intervention.

Ŷ Emergencies are major drivers of acute malnutrition

Ŷ Implementing standard protocol is challenging in emergencies

Ŷ -ȶȥʋơˉʋ࢚ɽɢơƃǫ˪ƃʋơȟɢȶɭŔɭˊŔƎŔɢʋŔʋǫȶȥɽʋȶʋɭơŔʋȟơȥʋɢɭȶʋȶƃȶȍɽ

Ŷ Several adaptations rather than one adaptation

Ŷ Aiming at improving coverage and reducing cost

Although limited in scope, context, and small-scale, evidence from previous implementations in
ƎǫljljơɭơȥʋƃȶʠȥʋɭǫơɽɽǠȶˁơƎʋǠŔʋŔɢɢȍˊǫȥnjɽǫȟɢȍǫ˪ơƎɢɭȶʋȶƃȶȍǫȥơȟơɭnjơȥƃˊɽơʋʋǫȥnjɽǠŔɽɢɭȶȟǫɽǫȥnj
ȥʠʋɭǫʋǫȶȥǫȥʋơɭʽơȥʋǫȶȥȶʠʋƃȶȟơɽࢎȥơˉơƃʠʋǫʽơŹɭǫơ˪ȥnjljɭȶȟŔʋơƃǠȥǫƃŔȍƃȶȥɽʠȍʋŔʋǫȶȥ࢏ࡲƃƃȶɭƎǫȥnj
ʋȶʋǠơɽǫȥnjȍơ࢚Ŕɭȟɢɭȶȶlj࢚ȶlj࢚ƃȶȥƃơɢʋʋɭǫŔȍǫȥ%ʠɭȇǫȥŔbŔɽȶ࡫áɭȶnjɭŔȟȟơȶʠʋƃȶȟơɽơˉƃơơƎơƎòɢǠơɭơ
standards (Daures et al 2020. https://pubmed.ncbi.nlm.nih.gov/31818335/).

In another intervention in Niger, the on integrated protocol in response to an emergency, the data
suggested effective treatment of MAM with RUTF, low defaulting, and reduced admissions for SAM
due to earlier treatment ࢎǠʋʋɢɽࡪࡸࡸˁˁˁࡲơȥȥȶȥȍǫȥơࡲȥơʋࡸljơˉࡸࠂࠀࡸɭʠʋ˪ȥȥǫnjơɭ࢏.

qơȥƃơ࡫ʋǠơɭŔʋǫȶȥŔȍơljȶɭŔƎȶɢʋǫȥnjɽǫȟɢȍǫ˪ơƎɢɭȶʋȶƃȶȍɽǫȥFʋǠǫȶɢǫŔǫɽʋȶɽŔʽơȍǫʽơɽˁǠơȥʋǠơˁŔɽʋǫȥnj
management protocol could not be implemented, to reach more children with malnutrition, to
treat MAM to prevent SAM, to use MUAC & edema as an admission criterion only for diagnosis
ʋȶ ŔƎƎɭơɽɽ ȍǫȟǫʋơƎ ǠʠȟŔȥ ɭơɽȶʠɭƃơ ƃŔɢŔƃǫʋˊ ŔȥƎ ǫȟɢɭȶʽǫȥnj ơlj˪ƃǫơȥƃˊ Ǝʠɭǫȥnj ơȟơɭnjơȥƃǫơɽࡲ zʋ
also helps to support national coordination platforms to lead on the use and documentation of
ɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠơɽʋȶʋǠơʋɭơŔʋȟơȥʋȶljƃǠǫȍƎˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽ࡫ˁǠơɭơˁŔɭɭŔȥʋơƎࡲ

zȥˁǠŔʋƃȶȥʋơˉʋƃŔȥʋǠơòǫȟɢȍǫ˪ơƎɢɢɭȶŔƃǠŹơŔɢɢȍǫơƎࡳ

These options are meant to be explored in the context of strengthening the quality and outreach
of SAM and MAM treatment programs, interventions to prevent malnutrition, and health system
strengthening during an emergency. They describe minimum options to deliver services, with the
intent to work towards in the implementation of the minimum package of treatment services in
line with national standards.

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 2
þǠơɽơȟơŔɽʠɭơɽɢɭȶʽǫƎơʋơȟɢȶɭŔɭˊȶɢʋǫȶȥɽljȶɭʋɭơŔʋǫȥnjˁŔɽʋǫȥnjǫȥʋǠơŔŹɽơȥƃơȶljþòbáŔȥƎࡸȶɭ¶þá
ŔȥƎŔɭơȟơŔȥʋljȶɭŔƃʠʋơƃɭǫɽơɽȶȥȍˊࢎɭŔɢǫƎȶȥɽơʋȶɭɢɭȶʋɭŔƃʋơƎƃɭǫɽǫɽˁǫʋǠŔɽǫnjȥǫ˪ƃŔȥʋʠȥơˉɢơƃʋơƎ
ɽɢǫȇơǫȥƃŔɽơȍȶŔƎ࢏ࡲzʋǫɽǫȥʋơȥʋǫȶȥŔȍȍˊ˫ơˉǫŹȍơʋȶŔȍȍȶˁljȶɭƃȶȥʋơˉʋȟȶƎǫ˪ƃŔʋǫȶȥɽŔȥƎǫɽȟơŔȥʋʋȶŹơ
adapted at country the level through the coordination mechanism of the nutrition cluster. These
ȶɢʋǫȶȥɽɢɭȶʽǫƎơƎȟŔˊȥȶʋɭơ˫ơƃʋŔȍȍʋǠơɢȶɽɽǫŹȍơƃȶȥ˪njʠɭŔʋǫȶȥɽʋǠŔʋȟŔˊŹơɢȶɽɽǫŹȍơǫȥƎǫljljơɭơȥʋ
contexts, this temporary protocol is to ensure that wasting treatment is not compromised. The
ȶɢʋǫȶȥɽȟŔǫȥȍˊljȶƃʠɽȶȥʋɭơŔʋȟơȥʋȶljʠȥƃȶȟɢȍǫƃŔʋơƎˁŔɽʋǫȥnjǫȥʋǠơ¶þáࡸþòbá࡫ˁǠǫȍơʋɭơŔʋȟơȥʋȶlj
complicated wasting will be in the stabilization center or for when a referral is not possible in an
emergency set up inpatient care management will be established (e.g., tent, school classroom,
etc) temporarily.

þǠơŔȍʋơɭȥŔʋǫʽơȟơŔɽʠɭơɽɽǠȶʠȍƎȶȥȍˊŹơŔɢɢȍǫơƎǫȥơˉʋɭơȟơȍˊɽɢơƃǫ˪ƃƃȶȥʋơˉʋɽˁǫʋǠŔɽǫnjȥǫ˪ƃŔȥʋ
ǫȥƃɭơŔɽơǫȥɭŔʋơɽȶljŔƃʠʋơȟŔȍȥʠʋɭǫʋǫȶȥ࡫ŔǠǫnjǠŹʠɭƎơȥȶȥƃǠǫȍƎȟȶɭʋŔȍǫʋˊॷƃȶȥ˫ǫƃʋŔɭơŔ࡫ơʋƃ

FˉɢơɭǫơȥƃơƎơȟȶȥɽʋɭŔʋơɽʋǠŔʋʋǫȟơ࢚ŹȶʠȥƎ࡫˫ơˉǫŹȍơɢɭȶʽǫɽǫȶȥȶljɽơɭʽǫƃơɽ࡫ʠɽơȶljɽɢơƃǫ˪ƃȥʠʋɭǫʋǫȶȥ
products, and the shifting of basic admission/discharge criteria may be appropriate and necessary
in certain situations. This is particularly so when barriers to providing the full continuum of care
for acutely malnourished children, such as supply, or capacity constraints can be addressed
through these temporary measures.

Scenario Recommendation Exit Criteria

If both SAM and MAM As per the national
Continue with national protocols
treatments are available. guideline
As a short-term measure, the Transition to regular
recommendation is to use expanded protocol when both
admissions criteria to admit children ¶þáŔȥƎþòbáŹơƃȶȟơ
ࠅ࢚ࠄࠈȟȶȥʋǠɽƃȍŔɽɽǫ˪ơƎˁǫʋǠŹȶʋǠò¡ available
ŔȥƎ¡¡ǫȥʋȶʋǠơ¶þáࢎ¡č-ऒࠀࠁࠄȟȟ
without lower limit), as a temporary If not, consider
measure in emergencies through Rapid
-MUAC>12.5 cm for two
Response Mechanisms. The dosage of
consecutive weeks.
RUTF recommended for Children in this
If SAM treatment is
Ǝȶƃʠȟơȥʋǫɽऒࠀࠀࠄȟȟࢎò¡࢏ŔɭơʋɭơŔʋơƎ -Clinically well
available however
with 2 RUTF sachets/day, and children
MAM treatment is not
ࠀࠀࠄ࢚ऒࠀࠁࠄȟȟࢎ¡¡࢏ŔɭơʋɭơŔʋơƎˁǫʋǠࠀ -Minimum stay of 3
available.
èčþbɽŔƃǠơʋࡸƎŔˊʠȥʋǫȍʋǠơˊŔɭơljʠȍȍ˪ȍȍʋǠơ weeks
discharge criteria.
-No edema for 2
*If the program is being run through weeks.
the health facility or mobile teams with
sustained access, routine medications
should be supplied as the likelihood
of completing the routine medication
schedule is higher.

3 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
The presence of one or more of the conditions/scenarios listed below will be used as the trigger
ljȶɭ ŔƃʋǫʽŔʋǫȥnj ŔȥƎ Ŕɢɢȍˊǫȥnj ʋǠơ ɽǫȟɢȍǫ˪ơƎ ŔȥƎ ƃȶȟŹǫȥơƎ ŔɢɢɭȶŔƃǠơɽࡲ þǠơ bơƎơɭŔȍ ¡ǫȥǫɽʋɭˊ ȶlj
Health will make this decision.

S.N Conditions / 7ơ˪ȥǫʋǫȶȥࡸȶɢơɭŔʋǫȶȥŔȍ Magnitude to consider as an

Scenarios Ǝơ˪ȥǫʋǫȶȥ emergency
At least half of the health facilities
ǫȥʋǠŔʋɽɢơƃǫ˪ƃŔɭơŔŔɭơȥȶȥ࢚
áǠˊɽǫƃŔȍŔƃƃơɽɽʋȶʋǠơǠơŔȍʋǠ
ljʠȥƃʋǫȶȥŔȍࢎʋǠǫɽƃŔȥŹơʽơɭǫ˪ơƎǫȥ
facility, presence health
Health facility MIRA or Rapid assessment).
1 workforce, and commodity
functionality
availability (essential lifesaving
Unavailability of the human
medicines and supplies)
resource-health workforce at health
facilities.
Disease out-break can aggravate
Outbreaks like measles, cholera,
2 Disease wasting caseloads in the
malaria, and others.
district.
Wasting
3 Wasting >15%
prevalence
District wasting caseload exceeds
If it exceeds abnormally
the estimate by 50%
Wasting compared to the trend analysis
4
caseload in the past and peaks the
The admission rate exceeds the
number of admission /cases/
monthly trend by 50%
Hotspot priority 1
5 Food insecurity
Integrated food security phase
ƃȍŔɽɽǫ˪ƃŔʋǫȶȥࢎzá-࢏ɢǠŔɽơɽࠃŔȥƎࠄ
Any displaced and isolated
population lives in the schools and
ȶʋǠơɭz7áƃơȥʋơɭɽࡲ
6 z7á
Any displacement and isolation of
population beyond the capacity of
local health care services.
-ȶȥ˫ǫƃʋࡸ ɭȟơƎƃȶȥ˫ǫƃʋȶɭɢɭȶȍȶȥnjơƎɽơƃʠɭǫʋˊ
7
instability or access situation in the district.
áȶƃȇơʋŔɭơŔɽ Hard to reach areas due to road
ȥˊƎǫlj˪ƃʠȍʋˊʋȶɭơŔƃǠʋǠơ
8 Ǝǫlj˪ƃʠȍʋʋȶ ǫȥŔƃƃơɽɽǫŹǫȍǫʋˊ࡫˫ȶȶƎǫȥnjƎʠɭǫȥnj
community in that area.
access rainy seasons, and other issues.

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 4
ĭǠơȥ ŔȥƎ Ǡȶˁ ʋȶ ɽˁǫʋƃǠ òǫȟɢȍǫ˪ơƎ
Approach to Standard Guideline for the
Wasting management.

þǠơ òǫȟɢȍǫ˪ơƎ ɢɢɭȶŔƃǠ ȥơơƎɽ ʋȶ Źơ 1. Adjustment of Admission Criteria (for early
switched to the standard acute malnutrition case detection and treatment)
Management Guideline when the above-
Ŷ MUAC and edema only: Admission,
mentioned considerations are improved. treatment, and discharge based on MUAC
and/edema only
Ŷ Functionality of health services restored,
or regular health and nutrition services Ŷ Expanded admissions criteria: Systematic
established. expansions of MUAC to include all children
ऒࠀࠁࠄȟȟ
Ŷ Wasting prevalence decreased to the
acceptable range. ࠁࡲ¡ȶƎǫ˪ƃŔʋǫȶȥɽȶȥáɭȶƎʠƃʋčɽơ
Ŷ Disease outbreak controlled. Ŷ Use of a single treatment product: Use
of RUTF for the treatment of all wasted
Ŷ Wasting caseloads and admission rate children in need of treatment
ɭơʋʠɭȥʋȶŔƃƃơɢʋŔŹȍơɭŔȥnjơࢎऒࠀ߿ह࢏ࡲ
Ŷ òǫȟɢȍǫ˪ơƎ 7ȶɽŔnjơࡪ 7ȶɽŔnjơ ȶlj èčþb
Ŷ z7áɽɭơʋʠɭȥơƎʋȶʋǠơǫɭǠȶȟơɽࡲ ɢɭȶƎʠƃʋȟȶƎǫ˪ơƎʋǠɭȶʠnjǠȶʠʋʋɭơŔʋȟơȥʋ

Ŷ -ȶȥ˫ǫƃʋ ŔȥƎ ǫȥɽʋŔŹǫȍǫʋˊ ŹŔƃȇ ʋȶ ɽŔljơ ŔȥƎ 3. Change in case management approaches
secure conditions.
(for early detection, better coverage, and
Ŷ Hard to reach areas can be accessible for access)
routine health services. Ŷ Family MUAC: Engaging family members
to screen and refer their children
ĭǠŔʋŔɭơŔɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠŔȥƎǫʋɽ
ƃȶȟɢȶȥơȥʋɽࡳ Ŷ CHW-led treatment of wasting:
Management of wasting by Community
Health Workers (health extension workers,
þǠơ òǫȟɢȍǫ˪ơƎ ŔȥƎ -ȶȟŹǫȥơƎ ɢɢɭȶŔƃǠ ǫɽ
other civil servants, volunteers)
intended to simplify and unify the treatment
of wasting for children ages 6-59 months Ŷ Reduced Frequency of Follow-up Visits:
Reducing the number of appointments
into one protocol to improve the coverage
throughout treatment
and continuity of care. These approaches are
designed to increase simplicity, which may When resources are scarce, this approach
be critical particularly in emergency contexts will:
where they can be applied as a short-term
Ŷ Eliminate the need for separate products,
ɽʋɭŔʋơnjˊࡲ þǠơɽơ ȟȶƎǫ˪ƃŔʋǫȶȥɽ Ŕɭơ ƃȍơŔɭȍˊ
infrastructure, and administrative
Ǝơ˪ȥơƎ ŔȥƎ࡫ ǠǫnjǠȍǫnjǠʋ ʋǠơ ơȍơȟơȥʋɽ ȶlj ʋǠơ procedures for wasting treatment
ɽʋŔȥƎŔɭƎ ɢɭȶʋȶƃȶȍ ʋǠŔʋ ǠŔʽơ Źơơȥ ȟȶƎǫ˪ơƎ
Ŷ Enable earlier treatment of cases
ŔȥƎ Ǡȶˁ ʋǠơˊ ǠŔʽơ Źơơȥ ȟȶƎǫ˪ơƎ ʋǠɭȶʠnjǠ before deterioration into severe wasting
ʋǠơɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠơɽࡲ treatment and

The most implemented and researched Ŷ Enable better continuity of care

ƃȶȟɢȶȥơȥʋɽȶljɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠơɽŔɭơࡪ

5 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
Objectives

Ŷ Improving coverage of wasting treatment as well as reducing the dosage of RUTF given
in emergencies, especially for moderately to each child, which reduces treatment costs
wasted cases per child. By expanding admission criteria
Ŷ To improve early case detection of wasting for CMAM programs to MUAC less than 12.5cm
at the community level, which is crucial (rather than less than 11.5cm), combined
for improving treatment outcomes. protocols aim to treat more children, earlier
Ŷ To prevent malnutrition, and health system before they reach the severe stage of
strengthening during an emergency acute malnutrition. CMAM programs using
combined protocols treat both moderate
Ŷ To rigorous research study to generate
wasting and uncomplicated severe wasting in
evidence for future policy change
an outpatient setting.
Management of acute malnutrition with Ŷ Identifying severe and moderate
Ŕɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠ wasting in the community, often by
using HEW, Community health worker,
The national Acute Malnutrition treatment or trained caregivers (usually mothers)
protocols put the treatment of both moderate to screen children using colored plastic
tapes to measure the mid-upper-arm
and severe wasting but recommend different
circumference (MUAC).
treatment strategies for each. Uncomplicated
cases of SAM are treated with ready-to-use Ŷ Assessment of children who meet the
criteria for uncomplicated severe or
therapeutic food (RUTF). The Moderate acute
moderate wasting and referrals to
malnutrition (MAM) component of Acute Stabilization center for those children
Malnutrition protocols relies on the use of who have SAM with complications and/or
ready-to-use supplementary food (RUSF) or infants under six months.
Specialized Nutrient Foods (SNF). Ŷ áɭȶʽǫƎǫȥnj Ŕ ɽʋŔȥƎŔɭƎǫ˖ơƎ ɽơʋ ȶlj ȟơƎǫƃŔȍ
treatments for SAM children to reduce
Ethiopia’s IMAM protocol, based on global infections, speed up nutritional recovery
guidelines, clearly includes treatment of both and prevent mortality.
Severe and Moderate Acute Malnutrition. The Ŷ áɭȶʽǫƎǫȥnj ɭơŔƎˊ࢚ʋȶ࢚ʠɽơ ʋǠơɭŔɢơʠʋǫƃ ljȶȶƎ
products to use are different for SAM and MAM. (RUTF)for treating malnutrition until
Therefore, having two products particularly children meet the criteria for discharge.
in areas with complex emergencies increases
the complexity of both supply and cases þǠơ ƃȶȟȟȶȥ ơȍơȟơȥʋ ʋǠŔʋ ɽǫȟɢȍǫ˪ơƎ
management systems. approaches cover is the detection and
treatment of both severe wasting and
òʋʠƎǫơɽ ƃȶȥƎʠƃʋơƎ ȶȥ ɽǫȟɢȍǫ˪ơƎ ŔȥƎ moderate wasting and acute malnutrition in
combined protocols from different program with one ready-to-use food (RUTF)
countries for CMAM treat children with both product.
severe and moderate wasting using RUTF.
These combined protocols aim to expand Also often have combinations of some of the
coverage by reducing the complexity of below elements, which have the potential to
implementation for healthcare practitioners, further streamline the approach and increase
coverage:

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 6
1. Admission and discharge
based on MUAC or edema
Admit and discharge children to a treatment approach is in line with National Guidance
program using Mid-Upper Arm Circumference includes important components of the
(MUAC) or edema. This can be a practical way standard protocols like always screening
to reach more children in the community for edema and for complications that would
with a diagnosis of acute malnutrition. The require inpatient treatment.

Table 3: Admission and Discharge criteria

Admission criteria for 6-59-month children Discharge criteria

Moderate wasting If admitted with bilateral pitting edema,
discharge cured when: No bilateral pitting
ࠀࠀࡲࠄऒए¡č-ऒࠀࠁࡲࠄƃȟAND No Edema No edema for 2 weeks with one-week ration.
medical complications Clinically well and alert AND
¡č-ओࠀࠁࡲࠄƃȟ
AND

Clinically well and alert.

Severe wasting If admitted based on MUAC, discharge is cured

ˁǠơȥࡪ¡č-ओࠀࠁࡲࠄƃȟljȶɭʋˁȶˁơơȇɽˁǫʋǠŔ
¡č-ऒࠀࠀࡲࠄȶɭ%ǫȍŔʋơɭŔȍɢǫʋʋǫȥnjơƎơȟŔऋȶɭऋऋ one-week ration

AND AND
No bilateral pitting edema
No medical complications Clinically well and
AND
ŔȍơɭʋáŔɽɽŔɢɢơʋǫʋơʋơɽʋ
Clinically well and alert.

2. Family MUAC
þǠơ ࢪbŔȟǫȍˊ ¡č-ࢫ ŔɢɢɭȶŔƃǠ࡫ Ŕȍɽȶ ȇȥȶˁȥ Ŕɽ Mothers are empowered to manage their
MUAC for mothers or Mother-MUAC, trains children’s health and HEW has more time to
mothers and other caregivers to identify early conduct other tasks.
signs of malnutrition in their children using a
simple-to-use Mid-Upper Arm Circumference *For the implementation of this approach
(MUAC) tape and by checking nutritional refer the National piloting Family MUAC
edema. guideline.

By moving this task to mothers (or other

family members), who can do it as effectively
as HEW, the cases are detected earlier, leading
to fewer hospitalizations.

7 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
3. Treat with a reduced dosage
ȶljèčþbŔɽŔɽɢơƃǫ˪ƃɢɭȶƎʠƃʋ

áɭơɽƃɭǫŹơɽ ʋǠơ ɽŔȟơ ȥʠȟŹơɭ ȶlj èčþb Similarly, one (1) sachet of RUTF for MAM
(2sachet) to all SAM children throughout their cases till their MUAC reaches 12.5cm. If
treatment until their MUAC reached 12.5cm. effective, it could improve cost-effectiveness
and treatment coverage.
Table 4: RUTF Dosage

-ǠǫȍƎɭơȥऒࠀࠀࡲࠄƃȟŔȥƎࡸȶɭnjɭŔƎơऋȶɭnjɭŔƎơऋऋ -ǠǫȍƎɭơȥࠀࠀࡲࠄƃȟ࢚ऒࠀࠁࡲࠄƃȟˁǫʋǠȶʠʋȟơƎǫƃŔȍ
oedema without medical complications. complications

RUTF: 2 Sacket/day/child RUTF: 1sacket/day/child

(14 sachets/per child/week) (7 sachets/per child/week).

4. Use Community Health

volunteer-to treat wasting
Empower trained community Health That is no medicines including antibiotics
volunteers to treat wasting without medical and deworming drugs will be used. CHV
complications at the community level. This need to be trained on (anthropometric
could be implemented as a last option when measurements, management of wasting,
Health facilities are not functional, heath referral, reporting and supply management),
work force are not in the area and any partners be offer ongoing technical support, their
are not accessing the area Community tasks/ responsibilities clearly explained,
Health volunteer can manage wasting using and their performance to be followed up –
ɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠơɽŔȥƎɭơƎʠƃơƎƎȶɽŔnjơȶlj training topics in the box beside.
RUTF approach without systemic treatment.

5. Reduce Frequency of
Follow-up Visits
Reducing the frequency of follow-up visits for This will reduce the burden of Health care
wasted children admitted into treatment from providers and Community Health volunteers
weekly to every two weeks is recommended so that they can have more time to admit and
with a possible home visit in case of access manage a greater number of children.
Ǝǫlj˪ƃʠȍʋǫơɽࡲ

Note: Follow-up visit for all edema cases should not be more than two weeks. If
possible, better to follow up on such cases on weekly bases.

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 8
 ƜőɱʗɡƜĈ-őȚƉ-ǗƜžǼǂȫɡȫƜƉƜȔő

MUAC <11.5 and or MUAC >/=11.5cm and <12.5cm MUAC >=12.5cm

bilateral pitting oedema and No bilateral pitting oedema No bilateral pitting oedema

Pass appetite test AND

Moderate wasting Normal
No medical complication

Severe wasting
without complication

íǠȔɖȂǠ˛ƜƉőȚƉžȫȔŵǠȚƜƉɖɡȫʀȫžȫȂʀȫȔőȚőDžƜʸőɱʀǠȚDž

bǫnjʠɭơࠀࡪòʠȟȟŔɭˊȶljʋǠơʋɭǫŔnjơljȶɭʋǠơɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎɢɭȶʋȶƃȶȍࡲ

þŔŹȍơࠄࡪ¡ŔȥŔnjơȟơȥʋȶljˁŔɽʋǫȥnjˁǫʋǠòǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎɢɭȶʋȶƃȶȍ

Admission criteria Severe Wasting Moderate wasting Severe wasting with

complication
-ǠǫȍƎɭơȥˁǫʋǠ¡č-ऒ Children with MUAC eɭŔƎơऋऋऋơƎơȟŔ
ࠀࠀࡲࠄƃȟŔȥƎࡸȶɭnjɭŔƎơऋȶɭ ࠀࠀࡲࠄƃȟ࢚ऒࠀࠁࡲࠄƃȟ and/or children
njɭŔƎơऋऋȶơƎơȟŔˁǫʋǠȶʠʋ without medical with other medical
medical complications complications complications
áŔɽɽŔɢɢơʋǫʋơʋơɽʋ zȥljŔȥʋɽऒࠅȟȶȥʋǠɽࡲ
Severe wasting with
any grade of edema
RUTF Ration RUTF: 2 sachets/ RUTF: 1 sachet/
per/day/child per/day child/
Or Or
14 Sachets per week/ 7 Sachets per week
child per child

Systematic Follow national Follow national Refer to the

treatment * acute malnutrition acute malnutrition stabilization center
management guidelines management
guidelines
Deworming
Amoxicillin
Vaccinations
Malaria treatment

9 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
 Frequency of visit Severe Wasting Moderate wasting Severe wasting with
complication

Weekly/Bi-weekly with Bi-weekly/Monthly

a frequent home visit by with a frequent
HEWs or HWs or CVs home visit by HEWs
or HWs or CVs

Discharge criteria ࢚¡č-ओࠀࠁࡲࠄƃȟljȶɭʋˁȶ ¡č-ओࠀࠁࡲࠄƃȟljȶɭ

consecutive weeks two consecutive Refer to the
-Clinically well measurements stabilization center
-No edema for 2 weeks
-Discharge with a one- -Clinically well
week ration -No edema
-Discharge with one-
week ration.

*When managing wasting by community volunteers becomes mandatory, the systemic treatment
does not apply. Community volunteers provide only RUTF without antibiotics or other medications.

Stakeholders implementing the

ɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎɢɭȶʋȶƃȶȍࡲ

Ministry of Health in coordination with The government the overall coordinator of

partners at national, regional, zonal, and the program, UN agencies, ENCU, and INGO
lower administrative levels is key. sill have their share of responsibilities.

Table 6: Roles and responsibilities of stakeholders

Stakeholder Role and responsibility

Ministry of Health ࢚áɭȶʽǫƎơɽȥŔʋǫȶȥŔȍnjʠǫƎŔȥƃơȶȥʋǠơǫȟɢȍơȟơȥʋŔʋǫȶȥȶljʋǠơɽǫȟɢȍǫ˪ơƎ

and combined protocol
࢚zȥƃȶȍȍŔŹȶɭŔʋǫȶȥˁǫʋǠ¥7è¡-ljŔƃǫȍǫʋŔʋơǫȥǫʋǫŔʋǫȶȥȶljŔɽǫȟɢȍǫ˪ơƎ
approach when the routine system is failed to respond.
-Ensures program quality through monitoring and supervision.
-Coordinates national activities including orientations, training, and
consultation workshops.
࢚¡ȶŹǫȍǫ˖ơɽɭơɽȶʠɭƃơɽljȶɭʋǠơǫȟɢȍơȟơȥʋŔʋǫȶȥȶljʋǠơɽǫȟɢȍǫ˪ơƎɢɭȶʋȶƃȶȍ
-Ensures a continuous supply of essential commodities to all Regional
Health Bureaus (RHBs
-Review implementation guidelines based on emerging evidence and
contexts.
-Evaluates the routine system functionality and decides when to
ƎơŔƃʋǫʽŔʋơʋǠơòǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠŔȥƎʋɭŔȥɽǫʋǫȶȥʋȶ
the routine treatment approach .

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 10
Stakeholder Role and responsibility

Regional and Zonal -Guides to the Zonal Health Department (ZHD) and Woreda health
Health bureaus ȶlj˪ƃơɽʋȶǫȥǫʋǫŔʋơɽǫȟɢȍǫ˪ơƎɢɭȶʋȶƃȶȍࡲ
࢚-ȶȥƎʠƃʋɽȟȶȥǫʋȶɭǫȥnjŔȥƎɽʠɢơɭʽǫɽǫȶȥȶljʋǠơq-ɽ࡫ŔȥƎqáɽŔʋʋǠơ
Woreda level.
-Mobilizes resources for training at the Regional, Zonal, and Woreda
levels
-Ensures quality and timely reporting of activities within the Region
and Zone.

ĭȶɭơƎŔqơŔȍʋǠ¶lj˪ƃơ ࢚FȥnjŔnjơáq-č࡫ƃȶȟȟʠȥǫʋˊǠơŔȍʋǠʽȶȍʠȥʋơơɭɽ࡫ŔȥƎƃŔɭơʋŔȇơɭɽȶȥʋǠơ
ǫȟɢȍơȟơȥʋŔʋǫȶȥȶljʋǠơɽǫȟɢȍǫ˪ơƎɢɭȶʋȶƃȶȍࡲ
-Coordinates and supports the training of health care providers and
HEWs.
-Ensures a continuous supply of essential commodities to all health
facilities
-Strengthens the referral and communication system between HCs and
qáɽࡲ
-Ensures that the HC service providers conduct regular supportive
ɽʠɢơɭʽǫɽǫȶȥȶljʋǠơqáɽࡲ
-Conducts supportive supervision and regular review meetings with
q-ɽŔȥƎqáɽࡲ
-Ensures timely reporting of activities to the ZHD.
࢚¡ȶȥǫʋȶɭʋǠơˁȶɭȇȶljǫȟɢȍơȟơȥʋǫȥnjɢŔɭʋȥơɭɽȶȥʋǠơɽǫȟɢȍǫ˪ơƎ
approach

þǠơáɭǫȟŔɭˊqơŔȍʋǠ ࢚áɭȶʽǫƎơɽȶɭǫơȥʋŔʋǫȶȥljȶɭqFĭɽȶȥʋǠơɽǫȟɢȍǫ˪ơƎɢɭȶʋȶƃȶȍࡲ
-Ŕɭơčȥǫʋࢎáqč࢏
࢚FȥɽʠɭơɽŔƃȶȥʋǫȥʠȶʠɽɽʠɢɢȍˊȶljèčþbʋȶŔȍȍqáɽˁǫʋǠǫȥʋǠơ‘ơŹơȍơ
catchment area.
࢚-ȶȥƎʠƃʋɽɽʠɢɢȶɭʋǫʽơɽʠɢơɭʽǫɽǫȶȥȶljʋǠơqáɽࡲ
࢚òʠŹȟǫʋɽŔƃƃʠɭŔʋơŔȥƎɭơnjʠȍŔɭòʋŔʋǫɽʋǫƃɽɭơɢȶɭʋɽȶȥʋǠơɽǫȟɢȍǫ˪ơƎ
protocol.

11 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
 Stakeholder Role and responsibility

HEWs -Ensure quality implementation of wasting management activities.

-Ensure continuous availability and proper utilization of the essential
supplies for wasting treatment
࢚áɭơɢŔɭơŔȥƎɽʠŹȟǫʋŔƃƃʠɭŔʋơŔȥƎʋǫȟơȍˊˁơơȇȍˊŔȥƎ¡ȶȥʋǠȍˊ
Statistical reports for the Management of waste.
-Engage with and build the capacity of the HDA and CVs on how to
conduct community mobilization, referral, follow-up, counseling, and
support of patients with acute malnutrition.
-Collaborate with the HDA and CVs to conduct home visits, follow-ups,
and referrals of wasted patients.
࢚Fȥɽʠɭơá•ĭŔȥƎljŔȟǫȍǫơɽˁǫʋǠˁŔɽʋǫȥnjɢŔʋǫơȥʋɽŔɭơơȥɭȶȍȍơƎǫȥʋǠơ
áɭȶƎʠƃʋǫʽơòŔljơʋˊ¥ơʋáɭȶnjɭŔȟŔȥƎȶʋǠơɭɭơȍǫơljɢɭȶnjɭŔȟɽࡲ

The Health -Early detection and refer cases of wasting based on MUAC and
Development Army/ Oedema
Health Development
࢚áɭȶʽǫƎơˁŔɽʋǫȥnjʋɭơŔʋȟơȥʋɽơɭʽǫƃơɽˁǠơɭơǠơŔȍʋǠƃŔɭơɢɭȶʽǫƎơɭɽŔɭơ
Group (HDA) and
not available
Trained caregivers
and Community -Manage the nutritious supplies at the community level and report to
volunteers the next level whenever it is functional
-Conduct health promotion and counseling at the community level,
and refer cases of wasting
-Counsels and supports the caregiver with treatment compliance
on the consumption of specialized nutritious foods and routine
medications.

NDRMC/DRMC -Coordinate and lead national and sub-national cluster coordination

meetings.
࢚áɭȶʽǫƎơɽȥŔʋǫȶȥŔȍnjʠǫƎŔȥƃơȶȥʋǠơȥơơƎŔȥƎŔƃʋǫʽŔʋǫȶȥȶljʋǠơ
ɽǫȟɢȍǫ˪ơƎɢɭȶʋȶƃȶȍǫȥƃȶȥɽʠȍʋŔʋǫȶȥˁǫʋǠb¡¶qࡲ
-Map out the scope and capacity of implementing partners and assign
partners in case of emergency.
-Mobilize resources.

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 12
Stakeholder Role and responsibility

UN Agencies -Advocate for the management of wasting, and children’s rights to

ljȶȶƎŔȥƎȥʠʋɭǫʋǫȶȥǫȥƃȍʠƎǫȥnjʋǠơɭȶȍȍȶʠʋȶljɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎ
protocol in cases of emergency
-Mobilize resources and provide funds for the implementation of the
protocol.
-Ensure availability of sustainable nutritious supplies
࢚áɭȶʽǫƎơʋơƃǠȥǫƃŔȍɽʠɢɢȶɭʋljȶɭʋǠơŔɢɢɭȶɢɭǫŔʋơǫȟɢȍơȟơȥʋŔʋǫȶȥȶljʋǠơ
ɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎɢɭȶʋȶƃȶȍ
-Support the FMOH and RHB to implement their respective roles and
responsibilities

Implementing ࢚áɭȶʽǫƎơʋơƃǠȥǫƃŔȍɽʠɢɢȶɭʋʋȶʋǠơŁq7࡫ĭȶɭơƎŔǠơŔȍʋǠȶlj˪ƃơ࡫q-ɽ࡫
áŔɭʋȥơɭɽ qáɽ࡫ŔȥƎƃȶȟȟʠȥǫʋǫơɽʋȶljŔƃǫȍǫʋŔʋơʋǠơȟŔȥŔnjơȟơȥʋȶljˁŔɽʋơǫȥŔȥ
integrated manner.
࢚òʠɢɢȶɭʋŁq7࡫ĭȶɭơƎŔǠơŔȍʋǠȶlj˪ƃơ࡫q-ɽ࡫ŔȥƎqáɽʋȶǫȟɢȍơȟơȥʋʋǠơǫɭ
respective roles and responsibilities.
࢚ĭǠơɭơɢȶɽɽǫŹȍơ࡫ǫȥʽȶȍʽơǫȥƎǫɭơƃʋǫȟɢȍơȟơȥʋŔʋǫȶȥȶljʋǠơɽǫȟɢȍǫ˪ơƎŔȥƎ
combined protocol in consultation with FMoH and NDRMC

Human resource, logistics and ࠀࡲࠁࡲ¡q¥þࡪ A Mobile Health & Nutrition Team is
monitoring, and evaluation comprised of technical personnel composed
of at least one 1midwife, 1 nurse, 1health
ࠀࡲࠀ qơŔȍʋǠ ˁȶɭȇơɭɽ ŔȥƎ qơŔȍʋǠ ơˉʋơȥɽǫȶȥ ȶlj˪ƃơɭ࡫ࠀɢǠŔɭȟŔɽǫɽʋ࡫ ŔȥƎ ࠀ ɢɽˊƃǠǫŔʋɭˊ ȥʠɭɽơࡲ
ˁȶɭȇơɭɽࡪ The preferred staff structure for the The MHNTs work six days per week, traveling
ɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠǫȥŔȥơȟơɭnjơȥƃˊƃȶȥʋơˉʋ from location to location and setting up
can include any health worker operating mobile clinics along the way. The MHNT can
in health care service in a designated be run by the government or partners (UN
health facility such as a nurse or clinician, agencies, INGOs). In areas where mobile health
Ŕ ȥʠʋɭǫʋǫȶȥǫɽʋ࡫ ȟǫƎˁǫljơ࡫ ŔȥƎ ǠơŔȍʋǠ ȶlj˪ƃơɭࡲ and nutrition teams are operating, especially
Health extension workers are trained health in an emergency, the management of severe
service providers at the health post level. In & moderate acute malnutrition (wasting
a context whether health system is active, the ȟŔȥŔnjơȟơȥʋ࢏ʋǠɭȶʠnjǠŔɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠ
ɭơƃȶȟȟơȥƎơƎ ɽǫȟɢȍǫ˪ơƎ ŔɢɢɭȶŔƃǠ ˁǫȍȍ Źơ should be applied by the responsible MHNT.
implemented and followed by health workers The MHNTs will schedule their movement/
and health extension workers assigned to distribution plan in such a way that children
provide standard nutrition services. Non- under follow-up for wasting will receive their
government staff will provide technical regular follow-up treatment for SAM and
support to government health workers to MAM with a reduced dosage of Ready-to-Use
ensure the quality implementation of the Therapeutic Food (RUTF).
recommended approach.

13 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
ࠀࡲࠂ Īȶȍʠȥʋơơɭࡪ A community volunteer is a ࠁࡲ-ŔɢŔƃǫʋˊŹʠǫȍƎǫȥnjljȶɭǠơŔȍʋǠˁȶɭȇơɭɽ࡫qFĭ࡫
member of a community who is chosen by ŔȥƎ-ȶȟȟʠȥǫʋˊʽȶȍʠȥʋơơɭɽࡪ Formal training,
community members or organizations to short orientation, and On-the-job training
provide basic health and medical care within are crucial before applying the recommended
their community and can provide preventive, ɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠzȥŔƎƎǫʋǫȶȥʋȶʋǠơƎǫɭơƃʋ
promotional, and rehabilitation care to that ǫȟɢȍơȟơȥʋơɭɽȶljʋǠơɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠ࡫ʋǠơ
community. In an emergency context where capacity building train needed to consider
the health system is collapsed or challenged health workers expected to follow the proper
to provide routine health and nutrition implementation of standards or protocols for
services and where there is an access problem quality approaches. Health workers and HEW
for a health worker or health extension will be provided with formal training just to
ˁȶɭȇơɭɽ࡫ ʋǠơ ɭơƃȶȟȟơȥƎơƎ ɽǫȟɢȍǫ˪ơƎ guide on the implementation of the procedure
ŔɢɢɭȶŔƃǠ ˁǫȍȍ Źơ ǫȟɢȍơȟơȥʋơƎ Źˊ ǫƎơȥʋǫ˪ơƎ followed by on job training and consistent
and trained community volunteers who can mentoring and follow-up to ensure quality
read and write At least 6 community health service. Community health workers will be
workers (2 per zone/Gote/Village) need to be trained formally, coached, and supported
ǫƎơȥʋǫ˪ơƎŔȥƎʋɭŔǫȥơƎɢơɭȇơŹơȍơࡲʽŔǫȍŔŹȍơ by HEW or HW until they are equipped with
government health worker INGO/NGOs staff the necessary knowledge and skill helps
will provide logistic support, technical follow, ʋȶ ǫȟɢȍơȟơȥʋ ʋǠơ ɽǫȟɢȍǫ˪ơƎ ŔɢɢɭȶŔƃǠơɽ ॷ
and coaching to community health workers. combined protocol. The capacity building
will also include supply management and a
proper storage mechanism.

ȥȶɭnjŔȥȶnjɭŔȟɽǠȶˁɽǠʠȟŔȥɭơɽȶʠɭƃơɽʋȶǫȟɢȍơȟơȥʋʋǠơɽǫȟɢȍǫ˪ơƎɢɭȶʋȶƃȶȍ

When Health System is When Health System is

functional not functional

Health workers Community Volunteers

and or HEWs MHNT and or WDAs

N.B: a combination of any of the human resource can be used as the context permits

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 14
Supply chain management for
treatment of child wasting through a
ɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠࡪ to take responsibility for nutrition supply
management (storage, stock management,
áɭȶʽǫɽǫȶȥ ȶlj ɩʠŔȍǫʋˊ ɽơɭʽǫƃơɽ ǫȥ ʋǠơ report, and request for supply, dispense
management of waste needs to establish supply for distribution) Transportation of
a good supply chain system. In applying supply and management to/at site will be
ʋǠơ ɽǫȟɢȍǫ˪ơƎ ŔɢɢɭȶŔƃǠơɽ ŔȥƎ ƃȶȟŹǫȥơƎ supported by government or partners (NGOs)
protocol, management procedure, it is in the area to support emergency nutrition
imperative to ensure consistent availability ɭơɽɢȶȥɽơ ʠɽǫȥnj ɽǫȟɢȍǫ˪ơƎ ŔɢɢɭȶŔƃǠơɽ ŔȥƎ
of supplies at the health facility level, combined protocol. Health workers (from
MHNT, or community level. The essential government or NGO staff) will supervise and
nutrition commodities for implementation ensure proper storage, proper utilization of
ȶlj ɽǫȟɢȍǫ˪ơƎ ˁŔɽʋǫȥnj ʋɭơŔʋȟơȥʋ ɢɭȶƃơƎʠɭơɽ the supply, proper recording system and stock
are RUTF, anthropometry equipment (MUAC management. Mobile health and nutrition
ʋŔɢơ ǫȥƃȍʠƎǫȥnj ɽǫȟɢȍǫ˪ơƎ ¡č- ʋŔɢơ ljȶɭ team/ static clinic can use their own storage
Family MUAC, printing materials (protocols, system or can directly dispatch and utilize the
quick references, patient follow up cards, supply on daily basis from available nearby
registration books, reporting forms, and health system storage.
referral slips stock management cards /bin
cards and stock register). Nutrition supplies should be stored based on
the standards of practice in supply storage
ࠁࡲࠀࡲ æʠŔȥʋǫ˪ƃŔʋǫȶȥ ŔȥƎ ɢɭȶƃʠɭơȟơȥʋࡪ or in a clean, dry and well-ventilated room
áɭȶƃʠɭơȟơȥʋ ȶlj ʋǠơ ɽơȍơƃʋơƎ ɢɭȶƎʠƃʋɽ ŔȥƎ to protect from pests, rodents and spoilage
other essential supplies should follow using pallets/plastic sheets. Ensure that
national and international emergency RUTF and other medicines are not stored
standards and regulations. The number of together with harmful chemicals. The store
supplies needed depends on the SAM or MAM should be lockable, well ventilated, has
caseload, the amount normally used in each shelves or wooden pallets (can be prepared
period (e.g., each quarter), the frequency of locally), supply should not have exposed to
requests, and the existing storage capacity. direct sunlight, expired, damaged, or items
no longer in use should be separated. At
ࠁࡲࠁࡲ ¶ɭnjŔȥǫ˖ǫȥnj ʋǠơ òʋȶɭơ ŔȥƎ ɽʋȶƃȇ kebele level available government institution
¡ŔȥŔnjơȟơȥʋࡪ At in an area whether re health such as health post, farmer training centre
system is functional the routine supply (FTC) or kebele admin store can be used to
management system will be followed. But store the supply.
in emergency context where there is no
functional health facility in the area or there ࠁࡲࠂࡲ ¡ȶȥǫʋȶɭǫȥnj ɢɭȶɢơɭ ʠʋǫȍǫ˖Ŕʋǫȶȥ ȶlj
is an access challenge, supply system will ɽʠɢɢȍˊࡪ To ensure minimize /avoid miss
Źơ ȟŔȥŔnjơƎ ǫȥ z7áɽ࡫ ¡q¥þ࡫ ŔȥƎ ǫȥ ȇơŹơȍơ utilization of supply especially when the
ȶlj˪ƃơɽ Źˊ ʋǠơ ƃȶȟȟʠȥǫʋˊ ʽȶȍʠȥʋơơɭɽ ĭǠơȥ ɽǫȟɢȍǫ˪ơƎ ŔɢɢɭȶŔƃǠ ǫɽ ǫȟɢȍemented by
community health workers/volunteers community health workers, it is crucial to
Ŕɭơ ɽơȍơƃʋơƎ ʋȶ ǫȟɢȍơȟơȥʋ ʋǠơ ɽǫȟɢȍǫ˪ơƎ overview proper utilization as frequently as
approach, one trained community health possible, compare the registered cases with
worker will be selected from each kebele distributed product recorded on bin card.

15 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
Government health workers or partners staff ࠂࡲࠁࡲ èơɢȶɭʋǫȥnjʋȶȶȍɽ
who provide technical support has to visit
cases recorded (sample), see their nutritional Ŷ Adopt the existing routine reporting form
ʋȶɭơ˫ơƃʋʋǠơɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠࡪ
status, ask for history of treatment to identify
and support if there any gap. Ŷ Some elements of data from the
reporting form will be removed
ࠂࡲ¡ȶȥǫʋȶɭǫȥnjŔȥƎơʽŔȍʠŔʋǫȶȥࢎɭơƃȶɭƎǫȥnjŔȥƎ (including, weight for height, and
ɭơɢȶɭʋǫȥnjʋȶȶȍɽ࢏ weight for length)

The standard management of acute Ŷ Additional information to be captured,

malnutrition recording, and reporting tools including by whom the screening is
will be used to record and report service done; who managed wasting treatment;
frequency of follow-up visits; if
ɢɭȶʽǫƎơƎ ʋǠɭȶʠnjǠ ɽǫȟɢȍǫ˪ơƎ ŔȥƎ ƃȶȟŹǫȥơƎ
admission, treatment, or discharge
approach. is based on MUAC and/or edema; the
admissions criteria used, product; and
ࠂࡲࠀࡲèơƃȶɭƎǫȥnjʋȶȶȍɽ treatment dosage of the product.
Ŷ To ensure an adequate implementation, Ŷ čȥƎơɭ ʋǠơ ɽơɭʽǫƃơ ƃȶȍʠȟȥ࡫ ¶þáࡸþòbá
performance and treatment outcomes, and SC elements will be replaced by
reporting for those children treated using Ŕ ɽǫȥnjȍơ ɽǫȟɢȍǫ˪ơƎ ŔȥƎ ƃȶȟŹǫȥơƎ
ʋǠơɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠơɽŔȥƎƃȶȟŹǫȥơƎ protocol.
protocol will be separate from routine
nutrition reporting and will be overseen Ŷ To capture evidence of coverage,
by emergency data management system. ơljljơƃʋǫʽơȥơɽɽ࡫ ŔȥƎ ơlj˪ƃǫơȥƃˊ ȶlj ʋǠơ
ɽǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠljȶɭƎơƃǫɽǫȶȥȟŔȇǫȥnj࡫
Ŷ Adopt existing CMAM registry, including, the analysis will be done using secondary
screening register, SAM register and MAM data retrieved from the adopted forms.
register
Ŷ Reporting and accountability hierarchy
Ŷ In the screening register, a separate
additional column will be included to Ŷ If the health system exists, CHW will
identify who performed the screening report to the nearest health facility
using the key which represent the code (health post, health center) while
of each performer mobile health and nutrition team will
Ǝǫɭơƃʋȍˊ ɭơɢȶɭʋ ʋȶ ʋǠơ ȥơŔɭŹˊ áq-čࡸ
Ŷ In SAM/MAM register, additional ˁȶɭơƎŔǠơŔȍʋǠȶlj˪ƃơࡲ
columns to be included to capture who
managed the treatment, product used Ŷ If the health system is not functional
and treatment dosage of the product. in the area, the report will be compiled
and sent to the functioning level of
Ŷ A single register adopted from routine the government health system (zone,
SAM/MAM register will be used to record region, or federal).
both Sever wasting and moderate
wasting cases of children 6-59 months

Ŷ þȶ ɭơƃȶɭƎ ljɭơɩʠơȥƃˊ࡫ ʋǠơ ơˉǫɽʋǫȥnj ¶þáࡸ

þòbá ƃŔɭƎ ˁǫȍȍ Źơ ʠɽơƎ ࢎljɭơɩʠơȥƃˊ ȶlj
ʽǫɽǫʋɽˁǫȍȍŹơŔɽɢơɭʋǠơɽǫȟɢȍǫ˪ơƎŔȥƎ
combined protocol).

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 16
17
ࠂࡲࠂࡲáɭȶɢȶɽơƎǫȥƎǫƃŔʋȶɭɽˁǫʋǠƎơ˪ȥǫʋǫȶȥŔȥƎljɭơɩʠơȥƃˊȶljɭơɢȶɭʋǫȥnj

Indicator 7ơ˪ȥǫʋǫȶȥ Frequency Disaggregation Data source Reporting Reporting level

level when the when the health
health system is system is not
functional functional
áɭȶɢȶɭʋǫȶȥȶlj Total number children Biweekly Disaggregated òǫȟɢȍǫ˪ơƎ qơŔȍʋǠáȶɽʋ Volunteers---
children 6-59 addressed with nutrition and Monthly Sex (Boy/girl), and combined --Health center--- MHNT____ Woreda
months screened screening during the Age protocol Woreda HO—Zonal HO---Zonal HD----
for malnutrition reporting period divided MUAC readings in cm Register HD---Regional HB RHB---MOH
ʋǠɭȶʠnjǠɽǫȟɢȍǫ˪ơƎ by total eligible under ¶ơƎơȟŔࢎ߿࡫ऋ࡫ऋऋ࡫ऋऋऋ࢏ ---MOH
approach 5 years children in the
area
The proportion The total number Biweekly Disaggregated òǫȟɢȍǫ˪ơƎ qơŔȍʋǠáȶɽʋ Volunteers---
of children 6-59 children of 6-59 months and Monthly Sex (Boy/girl), and combine --Health center--- MHNT____ Woreda
months severely severely wasted divided Age protocol Woreda HO—Zonal HO---Zonal HD----
wasted by the total number of Register HD---Regional HB RHB---MOH
6-59 months screened ---MOH
ʠɽǫȥnjŔɽǫȟɢȍǫ˪ơƎŔȥƎ
combined approach
during the reporting
period
The proportion The total number of Biweekly Disaggregated òǫȟɢȍǫ˪ơƎ qơŔȍʋǠáȶɽʋ Volunteers---
of children children of 6-59 months and Monthly Sex (Boy/girl), and combine --Health center--- MHNT____ Woreda
6-59 months moderately wasted Age protocol Woreda HO—Zonal HO---Zonal HD----
moderately divided by the total Register HD---Regional HB RHB---MOH
wasted number of 6-59 months ---MOH
screened using a
ɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎ
approach during the

ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
reporting period

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
 Indicator 7ơ˪ȥǫʋǫȶȥ Frequency Disaggregation Data source Reporting Reporting level
level when the when the health
health system is system is not
functional functional
Treatment **** Monthly Disaggregated by òǫȟɢȍǫ˪ơƎ qơŔȍʋǠáȶɽʋ Volunteers---
outcome for type of outcome and combine --Health center--- MHNT____ Woreda
Severe wasting (Recovered, died, protocol Woreda HO—Zonal HO---Zonal HD----
defaulted, non- Register HD---Regional HB RHB---MOH
respondent, medical ---MOH

ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
transfer, and transfer
out

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
Treatment **** Monthly Disaggregated by òǫȟɢȍǫ˪ơƎ qơŔȍʋǠáȶɽʋ Volunteers---
outcome for type of outcome and combine --Health center--- MHNT____ Woreda
Moderate wasting (Recovered, died, protocol Woreda HO—Zonal HO---Zonal HD----
defaulted, non- Register HD---Regional HB RHB---MOH
respondent, medical ---MOH
transfer, and transfer
out
Number of RUTF Total number of RUTF s Monthly Supply qơŔȍʋǠáȶɽʋ Volunteers---
carton in stock carton in stock for the or/and management --Health center--- MHNT____ Woreda
reporting period Biweekly register Woreda HO—Zonal HO---Zonal HD----
HD---Regional HB RHB---MOH
---MOH

18
References

ࠀࡲ %ȍŔƃȇ èF࡫ ĪǫƃʋȶɭŔ -e࡫ ĭŔȍȇơɭ òá࡫ %ǠʠʋʋŔ Ł࡫ -ǠɭǫɽʋǫŔȥ á࡫ Ǝơ ¶ȥǫɽ ¡࡫ ơʋ Ŕȍࡲ ¡ŔʋơɭȥŔȍ ŔȥƎ ƃǠǫȍƎ
undernutrition and overweight in low-income and middle-income countries. Lancet. 2013;
ࠂࠇࠁࡪࠃࠁࠆࢗࠄࠀࡲǠʋʋɢɽࡪࡸࡸƎȶǫࡲȶɭnjࡸࠀ߿ࡲࠀ߿ࠀࠅࡸò߿ࠀࠃ߿࢚ࠅࠆࠂࠅࢎࠀࠂ࢏ࠅ߿ࠈࠂࠆ࢚Ĵá¡z7ࡪࠁࠂࠆࠃࠅࠆࠆࠁ࢏

2. Naoko Kozuki, Mamoudou Seni et al. Adapting acute malnutrition treatment protocols in
ơȟơɭnjơȥƃˊ ƃȶȥʋơˉʋɽࡪ Ŕ ɩʠŔȍǫʋŔʋǫʽơ ɽʋʠƎˊ ȶlj ȥŔʋǫȶȥŔȍ Ǝơƃǫɽǫȶȥ ȟŔȇǫȥnjࡲ %¡- ࠁ߿ࠁ߿ -ȶȥ˫ǫƃʋ ŔȥƎ
Health (2020) 14:47 https://doi.org/10.1186/s13031-020-00293

3. National Guideline for the Management of Acute Malnutrition in Ethiopia, 2019

ࠃࡲþơƃǠȥǫƃŔȍ%ɭǫơljࡪòǫȟɢȍǫ˪ơƎŔɢɢɭȶŔƃǠơɽʋȶʋǠơʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnj࡫č¥z-Fbࡸ¡ŔȍŔˁǫࠁ߿ࠁ߿

19 eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ
 Annex I: Costing template
Annexes

eʠǫƎơȍǫȥơljȶɭɽǫȟɢȍǫ˪ơƎŔȥƎƃȶȟŹǫȥơƎŔɢɢɭȶŔƃǠơɽljȶɭʋǠơ
ʋɭơŔʋȟơȥʋȶljˁŔɽʋǫȥnjǫȥơȟơɭnjơȥƃǫơɽǫȥFʋǠǫȶɢǫŔ 20
April, 2023