The nutrition situation and wasting treatment/ integrated management of acute malnutrition (IMAM) in Myanmar Globally, 45.4 million children under five years of age are wasted. In 2012, the Sustainable Development Goals (SDGs) incorporated the World Health Assembly Resolution’s 2025 global targets to reduce and maintain wasting/ acute malnutrition to less than 5% but these targets are off track. In Myanmar, while wasting/ acute malnutrition has decreased from 13%3 in 1991 to 7%4 in 2018, the prevalence of wasting/ acute malnutrition remains above the global target and progress has likely deteriorated due to the COVID-19 pandemic and the coup d’etat in February 2021.
Wasting/ acute malnutrition treatment in Myanmar is integrated into the existing health service delivery system where healthcare workers who provide wasting/ acute malnutrition services also treat children with pneumonia, malaria and other diseases. Integrated management of acute malnutrition (IMAM) or wasting/ acute malnutrition treatment is delivered by basic health staff (BHS), community volunteers, local/ international non-governmental organisations (NGOs) and through government hospitals.
Nutrition-specific service provision in Myanmar had been decreasing since 2017, prior to the COVID-19 pandemic, leaving many children untreated and thus increasing the risk of malnutrition, morbidity and mortality. Nutrition services, including active wasting/ acute malnutrition case detection, referral and treatment, have been severely disrupted by insecurity and increased access restrictions since 2017.5 Service provision, including outside of Rakhine, has been further reduced by the COVID-19 pandemic and the recent political instability. Scale-up and uptake of wasting/ acute malnutrition treatment in Myanmar remains low with only 42.3% of children with severe wasting/ acute malnutrition and 20.4% of children with moderate wasting/ acute malnutrition targeted receiving treatment in 2021.6 A recent barrier analysis of wasting/ acute malnutrition treatment in Rakhine State, Myanmar identified the following key challenges and barriers:
● Difficulties obtaining travel authorisation (TA) for service provision for international and national NGOs to operate and for caregivers to travel to health facilities to seek treatment leads to gaps in providing and accessing wasting/ acute malnutrition treatment services. Caregivers who often have to travel long distances to seek treatment and cannot afford the transportation costs do not seek treatment. Therefore, children are either not treated or treatment is delayed, increasing risk of mortality.
● There is limited coverage of treatment services even in locations where nutrition partners and governments are operational. There has always been a low coverage of treatment services in Rakhine State but since the coup d’etat, several outpatient therapeutic programme (OTP) sites provided through government health facilities that were operational have not provided consistent services and funding for those locations was at times discontinued due to the approach of limiting engagement with the de facto authorities.
● Obtaining a memorandum of understanding (MOU) required by organisations providing services is a long process and is typically inflexible in changing service activities and locations, making scale-up of wasting/ acute malnutrition treatment difficult.