Severe acute malnutrition
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 can reduce the case-fatality rate by about 55% in hospital settings.
Recent studies suggest that severe acute malnutrition in children above 6 months of age who have no medical complications can be managed at the community level using specially formulated ready-to-use therapeutic foods. 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, American, South-East Asian and Western Pacific Regions.
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 with the advent of ready to use therapeutic foods (RUTF) which allows the management of a large numbers of children who are severely malnourished above the age of 6 months without medical complications through outpatient settings.
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. Community-based interventions along with hospital based interventions and functioning referral system for severely malnourished children with complications could transform the lives of millions of these children.