guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Community 26
All absences from OTP should be followed up by outreach workers, volunteers, focal point persons or
key community figures. It is important to gain an understanding of the reason for absence and to
encourage return.
It is critical that a defaulter or absentee is never reprimanded or treated disrespectfully. The reasons
for absenteeism are many, but the commonest relates to the staff attitude to the caretaker. If a
caretaker is treated badly, not only will the child be denied treatment for this episode, but if the child
recovers s/he is less likely to come to for treatment of future illness and the caretaker will pass a
negative message to her friends and neighbours. The reputation of the programme within the
community depends to a large extent upon spread of individual experiences informally. The staff must
all treat the parents of the children as those primarily responsible for the health of the child: they are in
effect part of the health team as far as that patient is concerned and should be treated as such.
Health Education, Mother-to-mother support with emphasis on breastfeeding
The parents and caretakers, whose children become malnourished, generally come from the poorest
sections of society. They frequently have not attended school and many cannot read or write. They
are often unaware of the nutritional needs of children, the importance of play and psychosocial
stimulation in child development, the effects of poor hygiene and pollution, the measures to take when
children become ill and the signs and symptoms of serious disorders. Basic facts about breastfeeding,
sexually transmitted disease and HIV, reproductive health and the ill effects of some traditional
practices are not known or ignored.
Such caretakers come together during an IMAM programme, either as in-patients or at the distribution
sites as outpatients and also at community level. It is important that these opportunities be taken to
hold education sessions for the caretakers, each week-day in the in-patient facility and each week at
the OTP site. In the community nutrition education should be a major part of the activities of the
mother-to-mother support groups and other groups within the community itself.
The In-patient multi-chart and OTP chart have a box for recording whether the caretakers have
attended the sessions.
Guidelines on Key Nutrition Information: Many packages and guidelines have been developed to
assist in IEC. The following are recommended:
The “Essential Nutrition Actions Package” (ENA) covers the following topics 24 :
1. Optimal breastfeeding;
2. Optimal complementary feeding;
3. Feeding sick and/or malnourished children;
4. Maternal nutrition;
5. Control of anaemia;
6. Control of iodine deficiency; and
7. Vitamin A supplementation
Other packages cover subjects such as growth monitoring, immunization, hygiene and sanitation and
de-worming.
For each of the above essential nutrition actions, there are either guidelines, policies or protocols that
are used for nutrition counselling at different points of contact with individuals or groups.
The sessions plan can be generated or modified locally to suit the prevailing problems of a region;
however there are basic health and nutrition messages that should be common to all programmes 25 .
24 http://www.coregroup.org/resources/core-tools - Booklet on Key ENA Messages 2011