guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM Contents 6 3. Medical complications (IMCI) ........................................................................................................ 34 • Specificity for HIV/TB patient ___________________________________________________________ 35 4. To summarise................................................................................................................................... 36 TRANSPORT OF SICK PATIENTS____________________________________________ 38 OUT-PATIENT TREATMENT PROGRAMME ___________________________________ 40 Admission ........................................................................................................................................... 40 Diet........................................................................................................................................................ 42 • Amounts to give______________________________________________________________________ 43 Routine medicines ............................................................................................................................. 45 1. NO other nutrients should be given ______________________________________________________ 45 2. Systematic Antibiotics _________________________________________________________________ 45 3. Duration of antibiotic treatment: _________________________________________________________ 46 4. Malaria _____________________________________________________________________________ 46 5. De-worming _________________________________________________________________________ 46 6. Measles ____________________________________________________________________________ 47 7. Vitamin A ___________________________________________________________________________ 47 8. Medicines for specific groups of SAM children in OTP. ______________________________________ 48 Surveillance in OTP ........................................................................................................................... 48 Transfer Out to In-patient care ........................................................................................................ 49 Failure to respond to treatment (out-patients) ............................................................................. 49 Discharge Procedure.............................................................................................................................. 54 1. Criteria of discharge __________________________________________________________________ 54 2. Recording the outcome of treatment _____________________________________________________ 54 Follow up after discharge................................................................................................................. 55 EMOTIONAL AND PHYSICAL STIMULATION __________________________________ 56 1. Emotional stimulation and play .................................................................................................... 56 2. Physical activity ............................................................................................................................... 57 IN-PATIENT CARE _________________________________________________________ 59 The principles of the management of In-Patient care ................................................................. 59 Diet (F75) ............................................................................................................................................. 62 1. Preparation _________________________________________________________________________ 62 2. Amounts to give______________________________________________________________________ 62 3. Naso-gastric feeding __________________________________________________________________ 63 4. Feeding technique____________________________________________________________________ 64 Routine Medicines ............................................................................................................................. 64 1. Systematic Antibiotics _________________________________________________________________ 64 The antibiotic regimen: ____________________________________________________________________ 64 2. Duration of antibiotic treatment _________________________________________________________ 66 3. Administration of antibiotics ____________________________________________________________ 66 Malaria .................................................................................................................................................. 67 Measles ................................................................................................................................................ 68
ACF-In Guidelines for the integrated management of SAM Contents 7 Medicines given under specific circumstances only.................................................................. 68 1. Vitamin A ___________________________________________________________________________ 68 2. Folic acid ___________________________________________________________________________ 69 3. Antihelminthics ______________________________________________________________________ 69 4. Other nutrients_______________________________________________________________________ 69 Surveillance ........................................................................................................................................ 69 Criteria to progress from Acute-Phase to Transition Phase ..................................................... 70 Treatment of Complications ............................................................................................................ 71 1. DEHYDRATION ................................................................................................................................ 71 • Diagnosis of dehydration ______________________________________________________________ 71 • Diagnosis of dehydration in the marasmic patient __________________________________________ 71 • Diagnosis of shock with dehydration in the marasmic patient _________________________________ 72 • Treatment of dehydration in the marasmic patient __________________________________________ 73 • Treatment of shock from dehydration in the marasmic patient ________________________________ 75 • Monitoring of rehydration ______________________________________________________________ 76 • Diarrhoea in the oedematous (kwashiorkor) patient_________________________________________ 78 • Persistent or chronic diarrhoea _________________________________________________________ 78 • Re-feeding diarrhoea after admission ____________________________________________________ 78 2. HYPERNATRAEMIC DEHYDRATION ........................................................................................... 79 • Diagnosis ___________________________________________________________________________ 80 • Treatment __________________________________________________________________________ 80 3. SEPTIC (OR TOXIC) SHOCK .......................................................................................................... 82 • Diagnosis of septic shock ______________________________________________________________ 82 • Treatment of septic shock _____________________________________________________________ 82 4. ABSENT BOWEL SOUNDS, GASTRIC DILATATION AND INTESTINAL SPLASH WITH ABDOMINAL DISTENSION. ................................................................................................................... 84 5. HEART FAILURE.............................................................................................................................. 85 • Signs and symptoms__________________________________________________________________ 85 • Treatment __________________________________________________________________________ 87 6. HYPOTHERMIA ................................................................................................................................ 88 7. FEVER ................................................................................................................................................ 89 8. SEVERE ANAEMIA .......................................................................................................................... 90 9. HYPOGLYCAEMIA........................................................................................................................... 91 • Clinical signs ________________________________________________________________________ 91 • Treatment __________________________________________________________________________ 91 10. Other conditions .............................................................................................................................. 92 11. DRUGS............................................................................................................................................... 92 12. Re-feeding syndrome ..................................................................................................................... 93 Severe Acute Malnutrition and HIV/AIDS ...................................................................................... 95 FAILURE TO RESPOND to treatment (in-patients) ...................................................................... 98 • Action required when failure to respond is commonly seen in a programme ____________________ 100 • Chronic diseases____________________________________________________________________ 100 TRANSITION PHASE ........................................................................................................................101 1. DIET ...................................................................................................................................................101 2. ROUTINE MEDICINE ......................................................................................................................104 3. SURVEILLANCE ..............................................................................................................................104 4. CRITERIA TO MOVE BACK FROM TRANSITION PHASE TO THE ACUTE PHASE ............104 5. CRITERIA TO PROGRESS FROM TRANSITION PHASE TO OTP ..........................................104
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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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