guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM Triage 30 They should be offered therapeutic feeding in the appropriate setting. AGE ADMISSION CRITERIA Less than 6 months See separate section for these infants. 6 months to 59 months • W/H - W/L
ACF-In Guidelines for the integrated management of SAM Triage 31 • If appetite test is passed, explain home care to mother and give IMCI treatment for the accompanying illness. Passing the appetite test is the main criterion for out-patient management. • If appetite test is failed, explain to the mother of the dangers of taking the child home and try to persuade her to accept in-patient care for at least a few days. Explain that she can take the child home for OTP care at any time. Also explain that if she changes her mind she can bring the child straight to the IPF. Note that the caretaker’s wishes must be respected if she still decides to choose to treat the child at home. For those who are not critically ill, but in-patient care is considered necessary and inpatient care does not necessitate prolonged travel, the nurse has to explain carefully the benefits of in-patient care, the risks of out-patient care and that the caretaker can change her mind at any time after admission with the agreement of the staff. The nurse has to accept the final decision of the caretaker and arrange appropriate care at home 30 . Similarly, if the patient passes the appetite test, but the mother wants several days of in-patient care, then the mother and child should be admitted to the IPF. 2. The appetite test and flow of patient Why to do the appetite test? � Malnutrition changes the way infections and other diseases express themselves – children severely affected by the classical IMCI diseases, who are malnourished, frequently show no signs of these diseases. However, all the major complications lead to a loss of appetite. Reasonably accurate assessment of the appetite is often the only way to differentiate a complicated from an uncomplicated case of SAM. � Even though the definition and identification of the severely malnourished is by anthropometric measurements, there is not a perfect correlation between anthropometric and metabolic malnutrition. It is metabolic malnutrition that causes death. By far the best sign of severe metabolic-malnutrition is a reduction in appetite, and the Appetite test is the most important criterion to decide if a patient should be sent for in- or out- patient management. A poor appetite means that the child has a significant infection or a major metabolic abnormality such as liver dysfunction, electrolyte imbalance, and cell membrane damage or damaged biochemical pathways. These are the patients at immediate risk of death. Furthermore, a child with a poor appetite will not take sufficient amounts of the diet at home to prevent deterioration and death. As the patient does not eat the special therapeutic food (RUTF) dispensed, the family will take the surplus and become habituated to sharing. How to do the appetite test? 1. The appetite test should be conducted in a separate quiet area. The children are all tested together in a group before they see the nurse/ person in charge of the OTP/IPF. Children that have travelled a long distance should be given water and allowed to rest quietly before the appetite test is conducted. 2. Explain to the caretakers the purpose of the appetite test and how it will be carried out. 3. The caretaker and child should wash their hands. 30 There are many reasons why the mother may not want the child admitted to in-patient facilities. She knows her circumstances better than the staff. Her other children, husband’s wishes, distance, expense, work load, security situation and the attitude of the staff can all influence her decision. If she is forced to in-patients she is likely to abandon treatment and not return to the programme to the detriment of the child for this episode and the reputation of the programme within the community; the mother is also likely to refuse care for any future episodes.
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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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