When World Vision Chad began implementing Community-based Management of Acute Malnutrition (CMAM) in Tara, a project area in Tandjile region, the local Traditional Birth Attendants (TBAs) readily engaged with the initiative. The TBAs explain that through their interaction with caregivers in the communities they saw the children looking very sick and after they received the training on CMAM they were so encouraged to have the opportunity to do something about it.
In addition to regularly screening the children and referring those with malnutrition to the CMAM programme, the TBAs asked World Vision for pictures of malnourished children so they can provide education to the mothers about malnutrition and then share information on nutritious complementary food. The TBAs include mothers with well-nourished children in their interactions by encouraging them to continue their good practices and giving them suggestions on how to prevent their children from becoming malnourished.
The CMAM approach relies on strong community participation to achieve the widest possible coverage. Community volunteers screen young children for malnutrition, referring those who require treatment of medical and/or nutritional needs. Volunteers support the Outpatient Therapeutic Programme with distribution of Ready-to-Use-Therapeutic Foods (RUTF), nutrient dense rations which require no preparation and are palatable to young children. Volunteers also follow up with defaulters and with children who recover and are discharged from the programme, to ensure maintenance of improvements in weight and health and provide re-referral if necessary.
TBAs are ideally suited for the CMAM community volunteer role because of their intimate connection with mothers and young children, and their respected position as traditional care providers in the community. The transformation the TBAs in the Tara project are making in their communities is visible in the positive response from mothers, with many women explaining the dramatic improvements in health they have seen in their children.
One woman described the change in her child this way: "My child was just a skeleton and ready to be thrown out, but since I have joined this programme, my child has recovered and is in good health now. My child is getting back to his normal shape."
The mothers also explain that before this interaction with the TBAs and World Vision, they didn’t know what to do with their children and they are so thankful that they now feel more confident that they can take care of their children and do not have to sit and watch them slowly fade.
World Vision Chad is currently implementing CMAM in 4 of its 16 project areas, with plans to scale up to additional districts over the next year. CMAM is implemented according to the protocol and strategic plans of the Ministry of Health. World Vision works in partnership with UNICEF for the supply of RUTF, the World Food Programme for the supply of supplementary feeding rations, and with various other organisations operating Stabilisation Centres for in-patient care of acutely malnourished children with medical complications.