Nutrition

Programmatic Aspects of the Management of Moderate Malnutrition

Consultation

24 -26 February 2010, Geneva, Switzerland

Background

Moderate malnutrition affects large numbers of children in poor countries. Children with moderate malnutrition have an increased risk of dying and it is estimated that moderate malnutrition is associated with a large number of nutrition-related deaths. In contrast to severe acute malnutrition, programmes of management of moderate malnutrition in children have remained virtually unchanged for the last 30 years - it seems timely to review how to improve their efficacy and effectiveness.

WHO convened a meeting in Geneva (September 30th - October 3rd, 2008) with the overall aim of answering the question on what diets should be used for moderately malnourished children. The consultation made recommendations on the nutrient content of diets, and on foods and ingredients suitable for feeding moderately wasted children; on food supplements that can be used to treat moderately wasted children, and on improved dietary counseling for these children and their caretakers. There was not enough evidence to make recommendations on treatment of stunting.

In follow-up of the first meeting this second consultation aims to review the evidence on strategies and programmatic approaches to managing moderate wasting not addressed in the first consultation last year.

Objectives

General Objectives:
  • To improve overall policy and evidence-based programme guidance on management of moderate malnutrition, with specific emphasis on children with moderate wasting (i.e. recommendation on package of interventions adapted to different settings).
  • To identify knowledge gaps that should be addressed by research both in the area of dietary management and the modalities for providing that diet.
Specific objectives:
  • To determine criteria for admission and discharge from specific programmes for moderately wasted children.
  • To estimate the burden of moderate malnutrition (i.e. expected numbers of moderately malnourished children).
  • To formulate recommendations on how to improve management of moderate cases of wasting in various settings using e.g. food supplementation and/or dietary counseling, and to determine when to start and when to stop specific programmes, and how to mainstream them in national health systems.
  • To formulate recommendations on how to improve monitoring of programmes on management of moderate wasting.

In each of these areas, if the evidence base is not strong enough to formulate recommendations, the meeting should recommend which type of research is needed to address current knowledge gaps.

Expected outcome (to be developed based on the agreed objectives)
  • Recommendations for improving programmes on management of moderate malnutrition, with specific emphasis on children with moderate wasting.

WHO will disseminate the proceeding of the meeting among relevant stakeholders. This will start the process for the development of preliminary recommendations for the programmatic aspects of managing moderate malnutrition. The meeting should also produce a detailed research agenda to generate the evidence needed to strengthen these preliminary guidelines.

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