NUTRITION & DIETETICS
Management of severe acute malnutrition in infants and children
Lecture 14
Presented by Dr. Abigail Kyei
Admission and Discharge Criteria for Under 5 children with Severe Acute Malnutrition (SAM)
1. Early identification of children SAM in the community by trained community health workers
Criteria for identifying children with severe acute malnutrition for treatment (Community)
Criteria for identifying children with severe acute malnutrition for treatment (Hospital)
2. Assessment of mid-upper arm circumference or the weight-for-height/weight-for-length status of infants and children under 5 years or 6–59 months of age
Infants and children with:
should be immediately admitted to a programme for the management of severe acute malnutrition.
Z-score (or SD-score) = (observed value - median value of the reference
population) / standard deviation value of reference population
Criteria for inpatient or outpatient care
3. Assessment of Children identified SAM with a full clinical examination to confirm whether they have medical complications and whether they have an appetite.
Treatment of children who have appetite (pass the appetite test) and are clinically well and alert should as outpatients.
Treatment of children with medical complications, severe oedema (+++), or poor appetite (fail the appetite test****) or present with one or more IMCI danger signs† as inpatients.
Oedema can be categorized as:
Mild (+): oedema in both feet/ankles
Moderate (++): oedema in both feet plus lower legs, hands or lower arms Severe (+++): generalized oedema including both feet, legs, hands, arms and face
Criteria for transferring children from inpatient to outpatient care
4. Transfer of children with SAM on admission at hospital to outpatient care when their medical complications, including oedema, are resolving and they have good appetite, and are clinically well and alert.
Determination of decision to transfer children from inpatient to outpatient care is by their clinical condition and not on the basis of specific anthropometric outcomes such as a specific mid- upper arm circumference or weight-for-height or length.
Criteria for discharging children from treatment
5. a. Discharge of children with severe acute malnutrition from treatment is only when their:
Criteria for discharging children from treatment cont’d
5. b. The anthropometric indicator that is used to confirm severe acute malnutrition is used to assess whether a child has reached nutritional recovery, i.e. if mid-upper arm circumference is used to identify that a child has severe acute malnutrition, then mid-upper arm circumference should be used to assess and confirm nutritional recovery.
Similarly, if weight-for-height is used to identify that a child has severe acute malnutrition, then weight-for-height should be used to assess and confirm nutritional recovery
Criteria for discharging children from treatment cont’d
5. c. Children admitted with only bilateral pitting are discharged from treatment based on whichever anthropometric indicator, mid- upper arm circumference or weight-for- height is routinely used in programmes.
Criteria for discharging children from treatment cont’d
6. Periodic monitoring of children with severe acute malnutrition who are discharged from treatment programmes to avoid a relapse.
References