Comparison of Project Peanut Butter and Ghana Health Service Malnutrition Management Protocols in Brong Ahafo, Ghana

Project Peanut Butter ProtocolGhana Health Service CMAM Protocol
SAM enrollment criteriaMUAC <11.5 cm or WLZ < −3 SD
Bilateral pitting edema
MUAC <11.5 cm or WLZ below −3 SD
Bilateral pitting edema
MAM treatment
MUAC ≥11.5 cm, <12.5 cm
WLZ between −2 and −3 SD
Enrolled and treated with RUTFIncreased nutrition counseling during CWC
RUTF dosage150 kcal/kg/day for SAM
75 kcal/kg/day for MAM
200 kcal/kg/day for SAM
Graduation criteriaMUAC >12.4 cm, or WFL > −2 SD for 1 visit (2 weeks)MUAC >12.4 cm, 3 consecutive weeks
No edema, 3 consecutive weeks
Discharge criteria3 consecutive visits missed (6 weeks)3 consecutive weeks missed
Maximum duration of treatment12 weeks16 weeks
  • Abbreviations: CMAM, community management of acute malnutrition; CWC, Child Welfare Clinics; MAM, moderate acute malnutrition; MUAC, mid-upper arm circumference; RUTF, ready-to-use food; SAM, severe acute malnutrition; WLZ, weight-for-length z score.