FOOD AND NUTRITION TECHNICAL ASSISTANCE Community Therapeutic Care (CTC): A new approach to managing acute malnutrition in emergencies and beyond

1 World Health Organization (WHO), Management of Severe Malnutr ition in Emergencies: A Manual for Physicians and Other Senior Health Workers (Geneva: 1999); and Ann Ashworth and Ann Burgess, Caring for Se verely Malnourished Children (Oxford: Macmillan Education and TALC, 2003). 2 United Nations Country Team. Focus on Ethiopia. September 3, 2003; and Claudia Hudspeth, HIV/AIDS and severe malnutrition in “Community based approaches to managing severe malnutrition,” Report on the proceedings of an inter-agency workshop. Dublin, 8-10 October, 2003 (Emergency Nutrition Network, February 2004). 3 Steve Collins, “Changing the way we address severe malnutrition during famine,” The Lancet 358 (2001): 498501. Traditionally, the management of severe acute malnutrition (SAM) in emergencies includes setting up therapeutic feeding centers (TFCs). Over the last decade, the focus has been on the attainment of acceptable minimum standards of mortality. Recovery and clinical outcomes in TFCs managed by experienced agencies has been positive. However, TFCs have critical limitations; they are difficult to establish, expensive to operate, and they often have very limited coverage. Furthermore, TFCs do not build on the capacity of the community, and at times, they can undermine traditional coping strategies. Mothers or caregivers are often required to stay with their malnourished children for three weeks or longer in the TFC. Such a demand has tremendous opportunity costs and disrupts family life. Moreover, the congregation of people in and around feeding centers can lead to the spread of infection, an important cause of increased morbidity and mortality in an already weakened population.