guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM Annexes 148 Annexe 3: anthropometric measurements 1. Checking for bilateral pitting oedema 2. Taking the MUAC 3. Taking the weight 4. Taking the length/height 5. Calculating the Weight/Height 1. CHECKING FOR BILATERAL PITTING OEDEMA Bilateral oedema is the sign of Kwashiorkor. Kwashiorkor is always a severe form of malnutrition. Children with bilateral oedema are directly identified to be acutely malnourished. These children are at high risk of mortality and need to be treated in a therapeutic feeding programme urgently. In order to determine the presence of oedema, normal thumb pressure is applied to the both feet for three seconds. If a shallow print persists on the both feet, then the child presents oedema. Only children with bilateral oedema are recorded as having nutritional oedema. Nutritional oedemas are classified as follows: + for feet, ++ for feet, tibia and forearm, +++ for the face and entire body.
ACF-In Guidelines for the integrated management of SAM Annexes 149 2. TAKING THE MUAC MUAC is used as an alternative measure of “thinness” to weight-for-height. It is particularly used in children from one to five years: however, its use has been extended to include children of over 65cm in height – or children of walking age. 1. Ask the mother to remove clothing that may cover the child’s left arm. 2. Calculate the midpoint of the child’s left upper arm by first locating the tip of the child’s shoulder (arrows 1 and 2) with your fingertips. Bend the child’s elbow to make the right angle (arrow 3). Place the tape at zero, which is indicated by two arrows, on the tip of the shoulder (arrow 4) and pull the tape straight down past the tip of the elbow (arrow 5). Read the number at the tip of the elbow to the nearest centimetre. Divide this number by two to estimate the midpoint. As an alternative, bend the tape up to the middle length to estimate the midpoint. A piece of string can also be used for this purpose; it is more convenient and avoids damage to the tape. Mark the midpoint with a pen on the arm (arrow 6). 3. Straighten the child’s arm and wrap the tape around the arm at the midpoint. Make sure the numbers are right side up. Make sure the tape is flat around the skin (arrow 7). 4. Inspect the tension of the tape on the child’s arm. Make sure the tape has the proper tension (arrow 7) and is not too tight or too loose (arrows 8 and 9). Repeat any step as necessary. 5. When the tape is in the correct position on the arm with correct tension, read and call out the measurement to the nearest 0.1cm (arrow 10). 6. Immediately record the measurement.
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Page 181 and 182: Cover photography: © ACF, Anne-Dom
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guidelines for the integrated management of severe acute malnutrition

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