guidelines for the integrated management of severe acute malnutrition

More documents

Recommendations

Info

ACF-In Guidelines for the integrated management of SAM Acknowledgements 4 ACKNOWLEDGEMENTS The foundation for these guidelines grew out of the work done at the Tropical Metabolism Research Unit, Jamaica from 1956 to 1991. The work was funded by the University of the West Indies and the Wellcome Trust. The physiological and nutritional knowledge gained formed the basis for the WHO (1999) guidelines for the management of Severe Acute Malnutrition. The guidelines were first applied by Action Contre Le Faim (ACF) in 1994 in Rwanda and subsequently applied in many Emergency situations. The experience gained showed the shortcomings of the WHO guidelines which were then extensively revised. The revised version formed the basis for many National Protocols which were then evaluated by the authors. The subsequent evolution of the guidelines depended upon these field evaluations of actual programmes, analysis of the data, identification of problems and situations not adequately addressed by current versions of the guidelines, research undertaken by students of the University of Aberdeen and deliberation by the ACF Scientific Committee. The ACF Scientific committee (M. Golden, A. Briend, Y. Grellety, C. Prudhon and D. Bounie) was instrumental in the formulation, development and initial testing of RUTF. This permitted effective treatment at home and large scale implementation of the treatment of SAM in the community. The subsequent testing of the products was largely undertaken by Andre Briend with collaborators and the implementation in emergency settings spearheaded by Steve Collins of Valid International with Concern Worldwide and Save the Children UK. We gratefully acknowledge the contribution of the agencies, field staff and students to this latest incarnation (version 6) of the guidelines. In particular, Action Contre la Faim-France and Action Contre la Faim-International contributed to the earlier revisions or the WHO guideline and UNICEF (country and regional offices) MSF-France and the European Community contributed to the later revisions by supporting evaluations of the programmes in the field. ACF addition: Andrew Tomkins, Carlos Navarro Colorado, André Briend; Sophie Laurence; Beatrice Mounier and Alix Haentjens have also contributed to revise previous version and finalisation of this version. The Protocol for SAM management is in constant evolution. ACF is following closely the studies and research performed by partners and is active in developing new evidence. Many questions are still pending and ACF will regularly update the protocol following the evolutions. Some example of ACF studies on-going: - Studies on anthropometric measurement to better identify the most relevant criteria for detection, admission and discharge in the nutrition programme. - Systematic antibiotic in SAM children study in 2011-2012 (Central African Republic) - “Alternative protocol” research (possibility of reducing the amount of RUTF given to the beneficiaries in OTP in the latest phase of treatment). Any errors or omissions are the responsibility of the Authors.
ACF-In Guidelines for the integrated management of SAM Contents 5 CONTENTS ACRONYMS _________________________________________________________________ 10 GLOSSARY__________________________________________________________________ 12 INTRODUCTION ___________________________________________________________ 13 1. The nature of malnutrition ............................................................................................................. 13 2. Treatment of disease in the malnourished is different from the normally nourished ....... 14 3. Prevention of complicated malnutrition...................................................................................... 15 ORGANISATION of an IMAM programme _____________________________________ 16 HIV, TB and SAM __________________________________________________________ 17 COMMUNITY ASPECTS OF IMAM____________________________________________ 18 1. Community involvement ................................................................................................................ 18 2. Planning the community programme .......................................................................................... 18 3. Community awareness and involvement.................................................................................... 19 4. Staff at community level ................................................................................................................ 20 • Existing health staff ___________________________________________________________________ 20 • Outreach Health workers ______________________________________________________________ 20 • Volunteers __________________________________________________________________________ 20 • Selection of volunteers ________________________________________________________________ 21 5. Screening, referral for treatment, follow-up and education .................................................... 22 • Screening___________________________________________________________________________ 22 • Active case finding in the community ____________________________________________________ 22 • Constraints__________________________________________________________________________ 23 • Tools ______________________________________________________________________________ 24 • Data collation ________________________________________________________________________ 24 • Passive screening in health structures, in the OPD and the Emergency room at hospital/health centre level ________________________________________________________________________________________25 • Other opportunities for screening _______________________________________________________ 25 • Follow-up ___________________________________________________________________________ 25 • Health Education, Mother-to-mother support with emphasis on breastfeeding ___________________ 26 TRIAGE PROCEDURE ______________________________________________________ 28 1. Definition of SAM – Criteria for admission to IMAM programme ........................................... 29 2. The appetite test and flow of patient ........................................................................................... 31 • Why to do the appetite test? ___________________________________________________________ 31 • How to do the appetite test? ___________________________________________________________ 31 • The result of the appetite test___________________________________________________________ 32
Page 1 and 2: �� ACF INTERNATIONAL GUID
Page 3: ACF-In Guidelines for the integrate
Page 7 and 8: ACF-In Guidelines for the integrate
Page 55 and 56:
ACF-In Guidelines for the integrate
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Cover photography: © ACF, Anne-Dom
show all

guidelines for the integrated management of severe acute malnutrition

Create successful ePaper yourself

Delete template?

Save as template?