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Integrated Management of Acute Malnutrition

Integrated Management of Acute Malnutrition



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Published by Mousham G Mhaskey

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Published by: Mousham G Mhaskey on Nov 24, 2008
Copyright:Attribution Non-commercial


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Integrated Management of Acute MalnutritionDiagnosis of Acute Malnutrition
Anthropometric Measurement Techniques
Before admission into therapeutic/supplementary feeding programs, it is commonpractice to retake anthropometric measurements for every child referred by thecommunity and/or primary health care settings. This is called a
. This ensures more control by the treatment-facility but may lead tochildren being referred but not admitted.Some programs are introducing the
one-stage process
, in which referral fromcommunity/primary health care settings entitle a child to admission withoutretaking anthropometric measurements. This enables the treatment-facility tofunction more efficiently by reducing delays and overcrowding but may haveimplications for the size of the program (particularly for supplementary feeding).Before admission into therapeutic/supplementary feeding programs, it is commonpractice to take
the following anthropometric measurements:
Mid-Upper Arm Circumference (MUAC)screening (for children with length> 65 cm). 
Weigh-for-Height (W/H) or Weigh-for-Length (W/L). 
Bilateraloedema.However, some treatment-facilities are using onlyMid-Upper Arm Circumference (MUAC)screening and bilateraloedemato confirm admission into therapeutic/supplementary feeding programs.Mid-Upper Arm Circumference (MUAC) screening and bilateral oedema areexplained in theEarly Detection and Referral of Children with Acute Malnutrition section.
Screening for Acute Malnutrition
Acute malnutrition
is a result of recent (short-term) deficiency of protein, energytogether with minerals and vitamins leading to loss of body fats and muscletissues. Acute malnutrition presents with
(low weight-for-height) and /or presence of pittingoedemaof both feet.
Screening for Acute Malnutrition
should be done at any contact points;children wards, immunization points, community out-reaches, ART sites, youngchild clinics, counselling units and psycho social groups. Community-basedservice providers can also perform malnutrition screening provided that they areadequately trained and equipped.Screening for acute malnutrition includes
Use and interpretation of 
Checking for 
Children with confirmed bilateral oedema are directly identified to beseverely malnourished and are recorded has having nutritional oedema.
Recognizing Visible clinical Signs
Marasmus signs
Prominent bones (ribs) 
Skinny limbs 
Loose skin (on lifting) 
Loose skin around the buttocks (buggypants)
Presence of bilateral pitting oedema 
Hair changes (brownish, scanty, straight) 
Skin changes (dermatosis) 
A large, protuberant belly
Checking for Bilateral pitting oedema
Apply gentle thumb pressure to both feet for 3 seconds. If a shallow print or pitremains on both feet when the thumb is lifted, then the child presents oedema.Only children with bilateral oedema are recorded as having nutritional oedema.These children are at high risk of mortality and need to be treated in atherapeutic feeding program urgently.Nutritional oedema always starts from the feet and extends upwards to other parts of the body.
Nutritional oedema can only beconfirmed by testing with finger pressure. You can not tell by just lookingCorrect testing for oedema with finger pressure
Normal thumb pressure should be appliedto
both feet
for three seconds(Source: Protocol for the management of Severe Acute Malnutrition, EthiopianFederal MOH, February 2007)
How to classify oedema

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