Research priorities to improve the management of acute malnutrition in infants aged less than six months (MAMI)

Worldwide, 8.5 million infants aged less than 6 months (<6m) are acutely malnourished. For the first time, 2013 WHO Malnutrition Guidelines describe their treatment, but on the basis of “very low quality” evidence, per WHO. More and better research is urgently needed. To prioritise the many possible research questions on infant <6m malnutrition, we used the systematic, transparent, well-established Child Health and Nutrition Research Initiative (CHNRI) approach. Sixty-four experts scored 60 research questions on the basis of their answerability, likelihood of intervention efficacy, effectiveness, deliverability, sustainability, impact on disease burden, and impact on equity. “How should infant <6m SAM be defined?” was the top-scoring research question; that this and other basic questions are still needed highlights paucity of evidence on this topic. Other leading questions reflect interest in public health/community-focused models of care, e.g., “What are priority components of a package of outpatient care?” These questions are important to inform new outpatient strategies now recommended by WHO. Most of our questions received high-priority scores reflecting a great need for a wide variety of evidence. Several major global initiatives such as the “Scaling Up Nutrition Movement” and “Generation Nutrition” would benefit from better evidence. Our results show clear ways forward for future research investments