guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM Triage 28 TRIAGE PROCEDURE This following shows the schema for decision making and the flow of patients. First the patient is identified in the community by MUAC and/or oedema assessment or in the health structure by MUAC, weight-for-height and looking for oedema. Those obviously severely ill are “fast tracked” to in-patient treatment by the person doing triage, they are not kept waiting – the triage person should regularly look at any waiting area. In all the structures which receive malnourished children, the welcoming procedure should be a priority 26 . This makes the treatment more understandable for the caretaker who will be then proactive in the treatment and increase the chance for the child to make a quick and better recovery. This includes organisation of the structure to look friendly (decoration, colours, toys available…) so that the children and caretaker to feel comfortable and also an explanation of how the centre is run to give the caretaker a good understanding of the treatment and organisation. (See ‘plan for an OTP opening’ in annex 2) The appetite test is performed whilst the referrals are waiting to see the nurse; the nurse looks for medical complications and has the result of the appetite test. She discusses with the caretaker and decides upon the appropriate treatment options. Those that need in-patient treatment are referred for admission to an IPF; those that can be treated as out-patients are admitted to the OTP programme immediately or referred the OTP site nearest to their home. The details are described in the next section. 26 Refer to “Manual for the integration of child care practices and mental health within nutrition programmes” page 14 the welcome
ACF-In Guidelines for the integrated management of SAM Triage 29 Direct admission to Out-Patient Patient passing appetite test and no medical complication, and mild/moderate oedema with willing carer Recovery phase Out-Patient treatment Screening Triage SAM Admission Criteria, Appetite test, Clinical examination Fail appetite test or Development of a medical complication Return of appetite and sufficient loss of oedema and no complication Discharge to follow up (SFP) Direct admission to In-Patient Patient falling appetite test or medical complication or severe oedema (+++) or no adequate carer Patient < 6 months Patient < 3 kg Acutephase Transition phase Recovery only if no OTP 1. Definition of SAM – Criteria for admission to IMAM programme All patients that fulfil any of the criteria 27 in the following table have severe acute malnutrition (SAM). 27 Since the late 1970s, the NCHS reference has been the anthropometric reference throughout the world. It is based on data from several samples of children from the USA, providing a description of the attained growth of American children (see table in annex 5). In 1993, the WHO undertook a comprehensive review of uses and interpretation of child growth references. The review concluded that new standards had to be developed that show how children across different countries should grow. WHO undertook the Multicentre Growth Reference Study (MGRS) between 1997 and 2003. Primary growth data and related information were gathered from 8,440 healthy breastfed infants and young children from diverse ethnic backgrounds and cultural settings. These child growth standards also support the notion that given the same environmental conditions, growth potential is independent of ethnic origin; therefore, these standards can apply in any country. Concerning MUAC cut-off, in WHO statement, recommendation follows the release of WHO standards for MUAC-for-age, which showed that in a well-nourished population there are very few children aged 6-59 months with a MUAC < 115 mm. Children with a MUAC < 115 mm also have a highly elevated risk of death compared to those who are above.
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Cover photography: © ACF, Anne-Dom
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guidelines for the integrated management of severe acute malnutrition

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