Dear Nicoly,

Thank you for your question. Currently the treatment of acute malnutrition (SAM and MAM), in infants 0-6m is provided exclusively through in-patient services in Ethiopia. The National Guidance for the Management of Acute MN was updated in May 2019 with the below admission criteria.

Infants 0-6 months of age should be managed in SC if they meet the following criteria:

‹. Any grade of bilateral pitting oedema (+, ++ or +++)

‹. WFL < -3 z-score

‹. Any serious clinical conditions or medical complications as outlined for children 6-59 months.

‹. Recent weight loss or failure to gain weight.

‹. Ineffective feeding (attachment, positioning and suckling) directly observed for 15-20 min, ideally in a supervised, separated area.

‹. Any medical or social issue needing more detailed assessment or intensive support (e.g.,

disability, depression of caregiver, or other adverse social circumstances).

Due to the only option being an in-patient service, curative care for SAM/MAM in infants <6m is still incredibly low, due to limited access and the various ‘costs’ to families (both financial and social). We know from our experiences with older children, that the option of outpatient care was a fundamental requirement to increase coverage. The same is needed for younger infants, hence to design of the MAMI Care Pathway.

With regards to children 6-59m, the inclusion of TSFP services for MAM treatment is only included in specific woredas, in priority areas, identified by the FMOH. Thus, in some areas, coverage will be 0% for MAM treatment. A number of SQUEACs have been conducted in Ethiopia over the last few years that includes a quantitative estimate of coverage, sometimes in locations only with SAM services, sometimes in sites providing both SAM & MAM care. Whilst we shouldn’t read too much into the point prevalence, that was designed as a rough proxy, many of the SQUEACs GOAL have conducted in the last 5years have provided coverage estimates of between 40-55%. This indicates around half the acute MN caseload being missed. NB: all the locations where GOAL would be conducting a SQUEAC will also have been prioritised by the FMoH for INGO partner capacity building support, thus we could assume coverage in other locations (without this additional support) may well be lower.