guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM In-patient: Transition phase 102 Even if the child is going to remain in a facility for recovery-phase, RUTF can be given for transition phase and subsequently; this relieves the burden on the staff of making up feeds frequently. It also means that there does not need to be a kitchen for the in-patient facility; this allows decentralisation of in-patient treatment to day-care (residential or non-residential) facilities at health centre level. Warning: F100 should never be given to be used at home. F100 is always prepared and distributed in an in-patient unit by staff trained in its use. F100 should not be kept in liquid form at room temperature for more than 3 hours before it is consumed, if there is a functioning refrigerator, constant electricity and a very clean kitchen/ utensils, then it can be kept (cold) for up to 8 hours (i.e. overnight). A whole day’s amount should never be made up at one time even with adequate refrigeration. RUTF can be used both in in-patient and out-patient programmes, does not require refrigeration and can be taken straight from the sachet. Table 16: Look up table for RUTF in Transition Phase per 24h Class of Weight Paste Sachets BP100 gram Sachets Bars 3 - 3.4 90 1.00 1.5 3.5 - 3.9 100 1.00 1.5 4 - 4.9 110 1.25 2.0 5 - 5.9 130 1.50 2.5 6 - 6.9 150 1.75 3.0 7 - 7.9 180 2.00 3.5 8 - 8.9 200 2.00 3.5 9 - 9.9 220 2.50 4.0 10 - 11.9 250 3.00 4.5 12 - 14.9 300 3.50 6.0 15 – 24.9 370 4.00 7.0 25 - 39 450 5.00 8.0 40 - 60 500 6.00 10.0 Total The amounts given in the table are for the full 24h period. The amounts represent an average increase in energy intake of about one third over the amount given during acute-phase. However, this varies between an increment of 10% and 50% depending upon the actual weight of the child and the product used. There are several products that are currently available: Kcal 500 550 600 700 800 1000 1100 1200 1350 1600 2000 2500 2700 � RUTF Paste is a manufactured (either locally or imported) anhydrous paste made up of dried skimmed milk, sugar, oil, vitamin & mineral mix and a flavouring - usually peanut butter. It contains about 5.4 kcal/g and is normally available in plastic pots of up to 250g or sachets of
ACF-In Guidelines for the integrated management of SAM In-patient: Transition phase 103 500kcal each weighting 96g. There are currently about 20 different manufactures worldwide 163 . � BP100 ® is a commercial product of Compact. It comes as compressed bars – each bar provides 300kcal. Each of these products is nutritionally equivalent to F100, with the exception that they have an appropriate amount of iron added during manufacture for children in recovery-phase (i.e. only for children who pass the appetite test and are not complicated). If both F100 and RUTF are being given they can be substituted on the basis that about 100ml of F100 = 20g of RUTF 164 . Table 17: Look up table on the amounts of f100 to give for 8 – 6 – 5 feeds per day Class of Weight (kg) 8 feeds per day 6 feeds per day 5 feeds per day Less than 3kg F100 full strength should not be given – Only F100 diluted should be given (see the section on infants less than 6 months) 3.0 to 3.4 kg 60 ml per feed 75 ml per feed 85 ml per feed 3.5 – 3.9 65 80 95 4.0 – 4.4 70 85 110 4.5 – 4.9 80 95 120 5.0 – 5.4 90 110 130 5.5 – 5.9 100 120 150 6 – 6.9 110 140 175 7 – 7.9 125 160 200 8 – 8.9 140 180 225 9 – 9.9 155 190 250 10 – 10.9 170 200 275 11 – 11.9 190 230 275 12 – 12.9 205 250 300 13 – 13.9 230 275 350 14 – 14.9 250 290 375 15 – 19.9 260 300 400 20 – 24.9 290 320 450 25 – 29.9 300 350 450 30 – 39.9 320 370 500 40 – 60 350 400 500 163 UNICEF supply division, Copenhagen, inspects the factories where these products are produced and ensures that the specifications conform to those laid down by WHO/UNICEF. It is strongly recommended that only products that conform to these specifications are used. Local manufacture is preferred, but the specifications must be followed exactly – although RUTF appears to be like peanut butter it is very different in its composition. 164 This is an acceptable approximation. If tables are to be constructed then 100 ml of F100 = 18.5g of RUTF: 10g of RUTF = 54ml of F100 should be used and the resulting values rounded to the nearest 5 or 10 ml
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Cover photography: © ACF, Anne-Dom
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