Hi-MAM Study: Treatment of High-Risk Moderate Acute Malnutrition using expanded admission criteria

One of the best ways to combat severe acute malnutrition (SAM) and its associated risk is to intervene before children become severely malnourished in the first place. However, there are currently no clear international guidelines for how to support moderately malnourished children, and to stop their deterioration.


This project uses four “high-risk indicators”, which may signal that a child is about to deteriorate from moderate to severe acute malnutrition, and tests two different types of early intervention.

It assesses whether the treatment of high-risk moderately malnourished children using ready-to-use therapeutic food (RUTF) results in better survival, growth and brain development than providing nutrition education for mothers, delivered through “mother support groups”.

The project is taking place in Pujehun District in Sierra Leone, and plans to treat and follow up 800 moderately malnourished children.


The intervention tries to find a practical programme design, which both streamlines treatment of SAM and MAM, requiring only one food product for all, while also only providing this expensive food intervention to those children most at risk. The research is expected to tell us whether the selected “high-risk” indicators are effective, and which MAM children can recover with nutrition counselling alone.

This should allow us to design the most effective and cost-effective treatment model for SAM and MAM, so we can increase treatment coverage, helping more children survive and thrive.

CONTACT: Mark Manary, Principal Investigator; Dr Natasha Lelijveld, Lead Researcher

RESEARCH CATEGORY: Simplified protocols for the treatment of acute malnutrition


DONOR: the innocent foundation

PARTNERS: Washington University School of Medicine; Project Peanut Butter; Centre for Global Child Health; Hospital for Sick Kids, Canada

Implementation: 2018
Final Data Collection: 2019
Final Results: 2020

Related Documents

Trial Registration: clinicaltrials.gov/ct2/show/NCT03647150

View all the research studies in the No Wasted Lives portfolio here