Management of Moderate and Severe Acute Malnutrition in Children

Abstract

Moderate acute malnutrition (MAM) i.e. weight for height z-score (WHZ) between -2 and -3 and severe acute malnutrition (SAM) i.e. WHZ score <-3 in children have serious consequences, contributing to increased morbidity and mortality, and require targeted interventions. Children with SAM and associated medical complications are at high risk of mortality and need facility-based management. The paper describes the guidelines by World Health Organization (WHO) and Indian Academy of Paediatrics (IAP) for inpatient and community based management of SAM. Experience of nutrition rehabilitation at National Institute of Nutrition, Hyderabad, has shown that it is possible to treat SAM children using local foods. A few studies that have also assessed the effectiveness of the Ready to Use Therapeutic Foods (RUTF) for the management of SAM in Indian settings have shown low mortality and high cure rates in non-defaulting children. More evidence on the costeffectiveness
and sustainability of this intervention is, however, required. The prevalence of MAM is much larger than that of SAM and children with MAM are also vulnerable to enhanced risk of mortality and morbidity. WHO has recommended that children with MAM should receive nutrient-dense foods to meet their extra needs for weight gain, height gain and functional recovery; however, there is no definitive consensus on the most effective way to treat children with MAM.
Finally, prevention of acute malnutrition requires a far wider spectrum of interventions beyond clinical management and need to focus on multi-sectoral actions.