e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Therapeutic feeding of children 6–59 months of age with severe acute malnutrition and acute or persistent diarrhoea

Intervention | Last updated: 9 August 2023

In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.

Diarrhoea is common in malnourished children and can result in decreased absorption of nutrients and significant water loss which can lead to dehydration, shock and ultimately death. Both acute and persistent (i.e. three or more loose or watery stools in a day, for more than 14 days) diarrhoea can worsen the harmful effects of severe acute malnutrition if left untreated. Episodes of prolonged diarrhoea are also associated with increased morbidity and mortality from other diseases, adverse neurodevelopment and stunting.

Although treatment and prevention of dehydration are essential, care of severely malnourished children must focus on the most effective and safest therapeutic feeding approach to resolve diarrhoea while meeting their nutritional needs.

WHO Recommendations

Children who are 6–59 months of age with severe acute malnutrition who present with either acute or persistent diarrhoea, can be given ready-to-use therapeutic food in the same way as children without diarrhoea, whether they are being managed as inpatients or outpatients.

Because ready-to-use therapeutic food does not contain water, children should also be offered safe drinking water to drink at will. Breastfeeding should be continued and offered ad libitum.

 



Evidence

Systematic reviews used to develop the guidelines

The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review

Picot J, Hartwell D , Harris P, Mendes D, Clegg AJ, and Takeda A. Health Technology Assessment. 2012; Vol.16:No.19(for Guideline: Updates on the management of severe acute malnutrition in infants and children).

Systematic review of the care of children with diarrhoea in the community-based management of severe acute malnutrition

Manary M, Iannotti L, Trehan I, Weisz A. Geneva: World Health Organization; 2012.

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Cost-effectiveness analyses

The analyses listed below were conducted to assess the overall cost-effectiveness of inpatient and/or outpatient management of SAM, of which the intervention listed on this webpage is a component. The analyses do not assess the cost-effectiveness of this specific intervention alone.

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Goudet S, Jayaraman A, Chanani S, Osrin D, Devleesschauwer B, Bogin B, et al. PLoS One. 2018; 13(11):e0205688.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif A-M C, Nonvignon J. Health. 2014; 6: 886-899.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

Puett C, Sadler K, Alderman H, Coates J, Fiedler JL, Myatt M. Health Policy Plan. 2013; 28(4):386-99.

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Tekeste A, Wondafrash M, Azene G, Deribe K. Cost Eff Resour Alloc. 2012; 10:4.

Cost-effectiveness of community-based management of acute malnutrition in Malawi

Wilford R, Golden K, Walker DG. Health Policy Plan. 2012; 27(2):127-37.

Costs, cost-effectiveness and financial sustainability of community-based management of acute malnutrition in northern Nigeria

Frankel S, Roland M, Makinen M. Washington DC: Results for Development Institute; 2015.

Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

Bachmann MO. Cost Eff Resour Alloc. 2009 Jan; 7:2.

The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K. Health Policy Plan. 1998; 13(3):249-62.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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Essential Nutrition Actions

This intervention is a component of managing children with SAM, which is an Essential Nutrition Action targeting the first 1000 days of life.

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