Severe Acute Malnutrition
Thanks to an appropriate management scheme, from being severely malnourished (weight 4.75 kg), this 2-year old girl not only gained 32% more weight in 3 weeks (weight 6.28), but she also gained an appetite for living.
1. Inpatient treatment of severe acute malnutrition
Severe acute malnutrition is defined by a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional oedema. Decreasing child mortality and improving maternal health depend heavily on reducing malnutrition, which is responsible, directly or indirectly, for 35% of deaths among children under five.
Although the median under-five case-fatality rate for severe acute malnutrition typically ranges from 30% to 50%, it can be reduced substantially when physiological and metabolic changes are taken into account. Management of severe acute malnutrition according to WHO guidelines reduced the case-fatality rate by 55% in hospital settings and recent studies suggest that communities such as ready-to-use therapeutic foods, can be used to manage severe acute malnutrition in community settings. In order to train health workers in applying this scheme WHO has created a course which, with the aid of institutional partners in Bangladesh, Chile, Gambia, Malawi and the UK, has been conducted in countries in the African, South-East Asia and Western Pacific Regions.
Example of reports on Inpatient training course on severe malnutrition
2. Community-based management of severe acute malnutrition in children
Severe acute malnutrition is a life threatening condition requiring urgent treatment. Until recently, the recommendation was to refer these children to hospital to receive therapeutic diets along with medical care. The situation changed recently with the advent of ready to use therapeutic foods (RUTF) which allows the management in the community of large numbers of children who are severely malnourished above the age of 6 months without medical complications. A meeting of experts was organized by the Department of Child and Adolescent Health and Development and the Department of Nutrition for Health and Development of the WHO, by UNICEF and the UN Standing committee on Nutrition in Geneva on 21-23rd November 2005 to review these recent developments and formulate recommendations. The report of this meeting is available on this web page. It is expected that implementation of these community-based interventions on a large scale along with a strengthening of referral facilities for severely malnourished children with complications could transform the lives of millions of these children.
WHO, UNICEF, and SCN Informal consultation on community-based management of severe malnutrition in children
Food and Nutrition Bulletin, Volume 27, Number 3, September 2006 (Supplement - SCN Nutrition Policy Paper no. 21)
WHO child growth standards and the identification of severe acute malnutrition in infants and children
A Joint Statement by the World Health Organization and the United Nations Children's Fund
Community-based management of severe acute malnutrition
A Joint Statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children’s Fund
WHO/UNICEF/IMTF Technical Review Committee Meeting on Management of Severe Acute Malnutrition
Scope and Purpose [pdf 38kb]
List of Participants [pdf 36kb]
World Health Organization, Geneva 28-29 June 2007
WHO, UNICEF, FANTA African Regional Training on Integrated Management of Severe
Dar es Salaam, 20th to 30th September 2006
Consultation on the dietary management of moderate malnutrition
Organized by WHO (Departments of CAH and NHD) in collaboration with UNICEF, UNHCR, WFP and supported by the IASC Nutrition Cluster
Geneva, Switzerland, 30 September to 3 October 2008
Severe acute malnutrition list of publications