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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Management of severe acute malnutrition in children 6–59 months of age with oedema

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.

Oedema is a swelling caused by the accumulation of fluid in the body tissues and can be categorized as

  • Mild (+): oedema in both feet/ankles
  • Moderate (++): oedema in both feet plus lower legs, hands or lower arms
  • Severe (+++): generalized oedema including both feet, legs, hands, arms and face

Children with severe acute malnutrition who have severe oedema (+++) have an increased risk of mortality compared to children with severe acute malnutrition but with lesser degrees of oedema.

WHO Recommendations

Children 6–59 months of age with severe acute malnutrition who have severe oedema (+++), even if they present with no medical complications and have appetite, should be admitted for inpatient care.

 



Evidence

Systematic reviews used to develop the guidelines

Management of oedematous malnutrition in infants and children aged >6 months: a systematic review of the evidence

pdf, 673kb Roberfroid D, Hammami N, Mehta P, Lachat C, Verstraeten R, Prinzo ZW, et al. Geneva: World Health Organization; 2013.

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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 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 therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

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

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 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.

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 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.

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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