CMAM COVID Adaptations: South Sudan Case Study (Concern Worldwide)
In South Sudan, Concern Worldwide runs an integrated program to treat children with severe and moderate
acute malnutrition in Central Equatoria, Unity and Northern Bahr el Ghazal States. Four of the 72 nutrition
sites are based in Protection of Civilian (PoC) sites for internally displaced persons (IDPs) in Juba and Bentiu.
In April and May 2020, following the South Sudan Nutrition Cluster’s COVID-19 guidance, Concern
Worldwide implemented adaptations to its nutrition programs aimed at minimizing the risk of COVID-19
transmission while continuing services for the management of child wasting. At facility level, hand washing
facilities were established at the entrance and in the compound, staff used hand sanitizer after each contact
with beneficiaries, physical distance of two meters was maintained, and temperatures were screened at the
entrance, among other measures. In addition to these IPC measures, protocol adaptations included:
(1) Modified admission criteria in CMAM programs;
(2) Modified dosage of therapeutic foods during AM treatment;
(3) Modified frequency of follow-up appointments during AM treatment; and
(4) Scale-up of Family MUAC and suspension of mass screenings.
Action Against Hunger, Concern Worldwide
USAID
The standard national CMAM protocol in South Sudan includes three independent admission criteria:
bilateral pitting edema, mid-upper arm circumference (MUAC), and/or weight-for-height Z-score (WHZ). COVID-19 guidance suspends the use of weight and height measurements in admissions, follow-up, and discharge to reduce contact between children, caregivers, and health workers. Therefore, only MUAC and edema are used as admission criteria under the revised protocol.
This modification enabled staff to continue providing treatment while reducing contact; however, program staff reported a significant drop in OTP and TSFP admissions, for example in Juba PoC in May and June. Positively, suspending weight and height measurements at the sites minimized contact between staff and enrolled children. Staff also train caregivers to take their own children’s MUAC at the sites to reduce contact further. Shifting to MUAC and edema as sole admissions criteria also reduced the time that caregivers spent at the sites, once they had been trained and became
confident in taking the MUAC measurements.