Stories
August 27, 2025 • 4 min read
Infants under six months are among the most vulnerable in crises, yet they are often overlooked, leaving mothers to navigate feeding and care with little support. The MAMI project bridges this gap by offering a holistic package that includes counselling, clinical assistance, and maternal mental health support. In Ethiopia, GOAL’s pilot and ongoing RCT equip healthcare workers with practical tools to identify and manage at-risk infants while building evidence to improve global guidelines.
In both natural and human-made crises, there are countless guidelines designed to address the health and nutrition needs of various population groups. Yet, one group is consistently overlooked: infants under six months old. Even outside emergency settings, these youngest and most vulnerable members of society are often affected by malnutrition, driven by a range of factors, including maternal mental health, lack of awareness, and poor support systems. While awareness of this issue is growing, practical, tailored solutions for their care and feeding remain scarce.
Breastfeeding is the recommended and sole source of nutrition for infants in this age group. However, it is also a deeply personal process that affects and is affected by a mother’s physical and emotional well-being. How often should a baby breastfeed? What happens if the mother is stressed and her milk supply is low? How should a child be attached to the breast and both the mother and infant positioned during breastfeeding? These are just some of the many questions mothers in rural communities are left to navigate alone, often without adequate support or information.
The MAMI Pilot Project
The Management of Small and Nutritionally At-Risk Infants under 6 Months and their Mothers (MAMI) project was designed as an innovative bridge to close the gap between community and clinical care for infants under six months at risk of poor growth and development. Beyond nutrition, the approach delivers a comprehensive package that combines counselling, clinical assistance, referral pathways, and ongoing follow-up. It also addresses critical areas such as maternal mental health and nurturing care to support early childhood development, ensuring both infants and their mothers receive holistic and sustainable care.
GOAL was the first international NGO to pilot the MAMI Care Pathway in a refugee setting, beginning in Ethiopia in 2016. A randomized controlled trial (RCT) of the pathway has been underway in Ethiopia until July 31st, 2025, testing how the MAMI package performs compared to existing national guidelines, which currently rely on standard Infant and Young Child Feeding (IYCF) counselling or inpatient care for complicated cases. In Deder district of East Hararghe Zone, Oromia region, GOAL is pioneering the use of rapid screening tools, in-depth assessments, digital data collection, and milestone follow-ups at 6, 12, 18, and 24 months. These innovations aim to equip healthcare workers with practical, efficient tools to better identify and manage vulnerable infants while building robust evidence to inform global guidelines, including future revisions of the WHO Malnutrition Guidelines.
Local Implementation: Laga Gabaa Health Centre
One of the sites which has been implementing the MAMI RCT project is the Laga Gabaa Health Centre in Deder district. Kidist Endale, a health professional at the facility, serves as the focal person for the project.
“There has been no attention or health and nutrition-focused approach for babies under six months. However, following the launch of the pilot project, the project provided us with the tools on how to respond to it. There is a digital follow-up mechanism where we record the progress of the children we follow up on, and once we provide the data, the system itself guides us on what to do next,” she explained.
Making a Difference: Neima’s Story
Two years ago, Neima Seid, a local mother, brought her baby Musa Nur to the health centre. During a routine assessment using MAMI tools, health workers found that Neima’s baby was at high risk of becoming malnourished unless immediate changes were made.
“Breast milk is the only food source that we educate mothers about, and when we find cases like Neima’s baby, we study their understanding and practice and guide the frequency of breastfeeding. If the mother is stressed and can’t produce a sufficient amount of milk, we provide her with relaxation therapy so that she can recover from the stress and take care of her baby,” said Kidist.
With ongoing follow-up, counselling, and emotional support, Neima’s baby began to improve gradually, becoming healthy and strong.
“I didn’t know either my baby’s condition or what I was supposed to do to help him get better. However, I was willing to seek support when the health worker said she could help me, and she consulted with me regularly, assisting in various ways. Not only did my child recover and become healthier, but he also became stronger than his elder siblings. Now I realised how many wrong things we were doing to our babies because of a lack of knowledge,” Neima shared.
Today, Neima’s baby Musa is a healthy two-and-a-half-year-old boy. Still, she continues to visit the health centre regularly for check-ups, committed to ensuring her son remains on the right track and determined to apply what she has learned to future caregiving.
