Integrated guidelines for the management of acute malnutrition. Review management of severe acute malnutrition in children. Outpatient care of children with acute malnutrition. Community based management of severe acute malnutrition sam 6 a community based approach to treating sam most children with sam without medical complications can be treated as outpatients at accessible, decentralised sites using rutf and simple medical protocols. Health system capacity and the cost of specialized nutrition products are major challenges with full integration into national health systems. Training guide for community based management of acute malnutrition cmam, 2018 version this cmam training guide is designed for health care managers and providers who manage, supervise, and implement services for the management of acute malnutrition, including those involved in community outreach activities. Aim of guideline the aim of this malnutrition guideline is a timely, optimal and uniform recognition and treatment of malnutrition related to disease and ageing.
Tfc all severe acute malnutrition is treated in the centre phase 1 and 2. The objective of the rehabilitation phase in dietary management of severe acute. The project trained health providers in integrated management of acute malnutrition, provided nutrition information to school children, and promoted the world health organizations infant and young child feeding practices and essential nutrition actions for improving maternal, newborn, infant, and young child health and nutrition. Coverage of communitybased management of severe acute. National consensus workshop on management of sam children through medical nutrition therapy. Protocol for the management of severe acute malnutrition. Along with the crude mortality rate, it is one of the basic indicators for assessing the severity of a humanitarian crisis. Communitybased versus health facilitybased management of acute malnutrition in reducing the percentage of severe acute malnutrition sam in children 659 months of age in low.
Integration of community based management of acute malnutrition. Multisectoral nutrition s 20142025 c a technical guidance. Management of children with severe acute malnutrition. Picture of measurement of height and weight for children. For communitybased management of acute malnutrition cmam1 or integrated management of acute malnutrition imam this will be the proportion of children with severe acute malnutrition sam who receive therapeutic care2. Management of severe and moderate acute malnutrition in children. These stress the importance of measuring coverage and set minimum standards for key indicators. Children exhibiting anorexia, or significant medical complications, such as severe anaemia, severe dehydration or severe infection complicated acute malnutrition should be hospitalised 2. The community based management of severe acute malnutrition is an attempt to achieve sustainable impacts at a population level by taking the socioeconomic realities into account, balancing the. Etiologybased malnutrition definitions other chronic diseases or conditions that can result in malnutrition. Community based management of severe acute malnutrition was. Overview of community based management of acute malnutrition.
Management of severe acute malnutrition in children. The centrebased care model follows the world health organization who guidelines for management of severe malnutrition. Training guide for communitybased management of acute. Fimnci is the integration of the facility based care package with the imnci package, to empower the health personnel. Community based versus health facility based management of acute malnutrition in reducing the percentage of severe acute malnutrition sam in children 659 months of age in low and middleincome. Degrees of malnutrition are associated with increased risk of allcause mortality and increased risk of. Diagnosis since no single factor is conclusive in determining the presence of adult malnutrition, diagnosis should be based on identifying at least two of the following characteristics. Programmatically, it is helpful to categorise children with sam into complicated and uncomplicated cases. Communitybased management of acute malnutrition cmam brings the services for. Community management of acute malnutrition in the developing. Communitybased management of acute malnutrition model. Stabilization centre only the most complicated 1015% of severe acute malnutrition cases are referred for inpatient care prior to referral to community based management programmes see below.
Cardiovascular disease, cancer, celiac disease, chronic pancreatitis, chronic obstructive pulmonary disease, congestive heart failure, cystic fibrosis, dementia. Cmam guidelines are merged with imci and iycf in some countries nepal. About 9% of subsaharan african and 15% of south asian children have moderate acute malnutrition23,24 and about 2% of children in developing countries have sam. To promote physical and psychosocial growth of children with severe acute malnutrition sam 3. Countries that have piloted the tool have already started using it. As per the context in ethiopia, a separate set of guidelines applies for.
The challenge of improving the management of hospitalised. Treatment of severe and moderate acute malnutrition in low. Assessment of coverage of communitybased management. There is also growing interest in the tool in other countries. This gap exists despite clear advances in the development and implementation of international and national protocols for the management of sam, as well as guidelines and training for inpatient care of severely acutely malnourished children. Severe acute malnutrition remains a major killer of children under five years of age. The brief focuses on current principles and approaches to moderate acute malnutrition mam management, highlighting key constraints, gaps in knowledge and areas still lacking consensus. District reports combine the information from individual. The communitybased approach involves timely detection of severe acute malnutrition.
Guidance for approaches for management of acute malnutrition. Severe acute malnutrition sam is defined as a weightforheight measurement of 70% or less below the median, or three sd or more below the mean national centre for health statistics reference values, the presence of bilateral pitting oedema of nutritional origin, or a midupperarm circumference of less than 110 mm in children age 15 years. Where to manage children with severe acute malnutrition who have oedema 23 3. Vitamin a supplementation in the treatment of children with severe acute malnutrition 31 5. The communitybased management of acute malnutrition cmam is one of world visions core project models in nutrition. Communitybased management of acute malnutrition in. Based on 2007 programme data and a number of key assumptions, community based management of acute malnutrition cmam in dowa, malawi was highly costeffective using the gni per capita threshold. Based on 2007 programme data and a number of key assumptions, communitybased management of acute malnutrition cmam in dowa, malawi was highly costeffective using the gni per capita threshold.
Key issues in the success of communitybased management of. Severe acute malnutrition sam is another types of acute malnutrition and one the most. Federal bureau of prisons medical management of malnutrition undernutrition clinical guidance september 2014 4 6. Use of antibiotics in the management of children with severe acute malnutrition in outpatient care 26 4. Acute malnutrition can be moderate or severe, and prolonged malnutrition can cause stunted growth, otherwise known as stunting. The cmam approach enables community volunteers to identify and initiate treatment by referring children with acute malnutrition before they become seriously ill. Coexistence of acute and chronic malnutrition needs to be comprehensively addressed with combined multiple approaches bergeron et al, 2012. Tools and procedures for classification of acute malnutrition. Identifying sam in the community, often by screening children using colored plastic strips to measure midupperarm circumference. The guide complements the who guidelines and protocols for the management of acute. Inpatient treatment for severe acute malnutrition is associated with high opportunity and. Rutf acquisition from 2000 to 2011, by metric tonnes and number of countries.
It is severe acute malnutrition if the wasting is severe wh federal bureau of prisons medical management of malnutrition undernutrition clinical guidance september 2014 2 figure 1. Community based management of acute malnutrition cmam. Community based management of acute malnutrition cmam is a strategy for identifying and treating uncomplicated sam without requiring hospitalization. Costeffectiveness of communitybased management of acute. Malawi guidelines for communitybased management of acute. We could not find any study on community based management of suw children. Moderate acute malnutrition mam, also known as wasting, is defined by a weightforheight indicator between 3 and 2 zscores standard deviations of the international standard or by a midupper arm circumference muac between 11 cm and 12.
Addressing acute malnutrition world vision international. Dec 17, 2012 cmam is a methodology for treating acute malnutrition in young children using a casefinding and triage approach. The challenge of improving the management of hospitalised children with severe acute malnutrition. November 2008 a significant gap remains between need and capacity for management of severe acute malnutrition sam in children. Jun 04, 2015 community based treatment of severe acute malnutrition sam allows the majority of malnourished children to be treated at an outpatient clinic on a weekly or fortnightly basis with only the most severe cases being admitted to inpatient centres for short periods. Pdf communitybased management of acute malnutrition in. It is therefore necessary to include suw children, in addition to sam cases, in a community based therapeutic feeding project. Coverage as a key indicator for the management of acute malnutrition. Summary of suggested criteria for admission for sam used in children five years or older. This technical brief is one of three commissioned by the community based management of acute malnutrition cmam forum. Action against hunger treats acute malnutrition with a combination of community based management and.
Pdf communitybased versus health facilitybased management. Iv fluids in the management of severe acute malnutrition. Global acute malnutrition gam is a measurement of the nutritional status of a population that is often used in protracted refugee situations. Community based management of severe acute malnutrition can have a major public health impact with modern treatment regimens and improved access to treatment, casefatality rates can be as low as 5 per cent, both in the community and in healthcare facilities. World vision uses the communitybased management of acute malnutrition cmam model, which strengthens communities to both identify and treat malnourished children. Management of acute malnutrition in infants mami project. Recent history in the management of severe acute malnutrition sam. Acute malnutrition is classified into severe acute malnutrition1 sam and moderate acute malnutrition mam according to the degree of wasting and the presence of oedema. To assess the feasibility and constraints of communitybased management of acute malnutrition cmam, a relatively new approach, in. We could not find any study on communitybased management of suw children. Community based management of acute malnutrition technical guidance brief. Cmam is a methodology for treating acute malnutrition in young children using a casefinding and triage approach. It may be possible to combine existing mobile health workers, such as mch. To provide clinical management and reduce mortality among children with severe acute malnutrition, particularly among those with medical complications 2.
Communitybased management of acute malnutrition givewell. Management of severe acute malnutrition, orgpublicationsfiles. World vision uses the community based management of acute malnutrition cmam model, which strengthens communities to both identify and treat malnourished children. In children aged 659 months, a muac less than 110 mm indicates severe acute malnutrition, which requires urgent treatment. It is severe acute malnutrition if the wasting is severe wh community based management of severe acute malnutrition can have a major public health impact with modern treatment regimens and improved access to treatment, casefatality rates can be as low as 5 per cent, both in the community and in healthcare facilities. Severe acute malnutrition, community management of acute malnutrition, readytouse therapeutic food, developing countries. Directly observed therapydot etc while attending cmam or combine.
The leading killers are prematurity and pneumonia, responsible for 17. Using the cmam method, malnourished children receive treatment suited to their nutritional and medical needs. Components of communitybased management of acute malnutrition. The main value added of ipc for acute malnutrition is that it enables classification of areas based on different methods and indicators of acute malnutrition with clear parameters for minimal reliability needed, and also. Action communitybased management of acute malnutrition. A training package on outpatient management of acute malnutrition using rutf was developed and a consensus meeting was held to agree on the contents and pre tested in a combined 5 days training of trainers and service providers.
Communitybased management of severe acute malnutrition. The 2011 sphere standards3 see box 1 set the minimum acceptable levels of coverage for the management of acute malnutrition in different settings during a humanitarian response. It is therefore necessary to include suw children, in addition to sam cases, in a communitybased therapeutic feeding project. Review of communitybased management of acute malnutrition. Most malnourished children can be rehabilitated at home with only a small number needing to travel for inpatient care. For community based management of acute malnutrition cmam1 or integrated management of acute malnutrition imam this will be the proportion of children with severe acute malnutrition sam who receive therapeutic care2. World vision treated 118,242 children with acute malnutrition in fiscal year 2017 1 october 2016 to 30 september 2017.
Assessment of coverage of communitybased management of acute. Stunting in early childhood has health consequences that can affect children throughout their entire lives. Updates on the management of servere acute malnutrition in. Contents the first chapter of the guideline covers definitions, risk indicators, different types of malnutrition, and the causes, consequences and prevalence of malnutrition. Few countrieseven among those with a high prevalence of malnutritionhad a clear national policy for detecting and treating sam children. Communitybased management of acute malnutrition cmam. Communitybased management, community therapeutic care. Guidelines for management of severe acute malnutrition.
1347 735 25 493 1091 1174 1200 1336 1370 1219 112 385 827 965 1142 316 128 1232 361 864 995 490 1413 993 246 693 765 156 695 1327 318 602 239