MANAGEMENT OF ACUTE MALNUTRITION IN ZIMBABWE

A QUICK REFERENCE GUIDE

MINISTRY OF HEALTH AND CHILD WELFARE

VERSION I (MAY 2011)

Copyright May 2011, Ministry of Health and Child Welfare, Harare,

Zimbabwe

Copies of this guide can be obtained from the National Nutrition

Department, Ministry of Health and Child Welfare, in Harare, Zimbabwe.
Please visit our website: http://www.mohcw.gov.zw/

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 ACKNOWLEDGEMENTS

We are grateful to all those involved in the management of acute

malnutrition in Zimbabwe. A special thank you is extended to those
involved in the development of the draft National CMAM Guidelines – the
source material from which this quick reference guide has been
developed.

The following people and organizations were critical in the development

of this guide:

CMAM Task Force Members

K. Nyadzayo, MoHCW National Nutrition Department
V. Makanganise, MoHCW National Nutrition Department
R. Danda, MoHCW, Parirenyetwa Group of Hospitals
T. Stillman, Cluster Coordinator, UNICEF
P. Mudzongo, Program Officer, UNICEF
T. Ndumiyana, Program Officer, World Food Program

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 ORGANIZATION OF THE QUICK REFERENCE GUIDE

Section 1: Introduction to the Quick Reference Guide Page 4

Section 2: Classification of Acute Malnutrition Page 6

Section 3: Feeding Formulas for Malnourished Individuals Page 7

Section 4: Admission and Exit Criteria Page 9

A. Inpatient Therapeutic Care (Stabilization) Page 13

B. Outpatient Therapeutic Care Page 17

C. Supplementary Feeding Page 22

Section 5: Look up Tables

A. Children 6-59 Months of Age Page 25

B. Children and Adolescents 6 to 18 Years of Age Page 29

C. Adult BMI Page 33

D. 15% Weight Gain Reference Table Page 35

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 SECTION 1
INTRODUCTION TO THE QUICK REFERENCE GUIDE

Purpose
This booklet provides practical guidance for the administration of
therapeutic foods to patients with acute malnutrition through hospitals and
health centres in Zimbabwe. It seeks to promote the best available therapy
to reduce the risk of death, shorten hospitalization, and facilitate full recovery
of acutely malnourished individuals. The booklet is aimed at health
personnel working at all levels of the health delivery system, including
Doctors, Nurses, Nutritionists, Dieticians and Auxiliaries.

The booklet is designed as a quick reference guide – it is NOT a

comprehensive treatment guideline. The quick reference guide should be
used together with other available guidelines for the management of acute
malnutrition and other illnesses. The booklet does not contain information
regarding the clinical management of nutrition related complications –
treatment that is essential to the recovery of malnourished individuals.
Introduction

Background
Malnutrition remains one of the most common causes of morbidity and
mortality among children throughout the world. According to global
estimates, 35% of all child mortality is attributable to maternal and child
1
under nutrition – applying these estimates to Zimbabwe, malnutrition may
contribute to nearly 12,000 child deaths each year.

Acute malnutrition, defined by a low weight for height (children), low body
mass index (adolescents and adults), presence of bi-lateral pitting oedema,
or low mid-upper arm circumference, is the most immediate form of
malnutrition. The risk of death in children with severe acute malnutrition
(SAM) is 10 times greater than the risk of death in their well nourished
counterparts, and the risk of death in children with moderate acute
malnutrition (MAM) is more than 2 times greater than in their well-
2
nourished counterparts. The risk of dying increases with the severity of the
condition.

HIV and malnutrition are inter-related: HIV progressively weakens the

immune system and impairs nutritional status through the reduced intake,

1
Black et al., 2006, Lancet
2
Collins et al., 2006, Lancet
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mal-absorption of nutrients, and increased metabolic requirements, while
malnutrition exacerbates the effects of HIV by increasing susceptibility to
3
AIDS related illness . Reports from routine program monitoring suggest that
up to 70% of children admitted for treatment of SAM in Zimbabwe are HIV
infected. Furthermore, it is estimated that 18 percent of chronically ill
patients in Zimbabwe suffer from accompanying acute malnutrition (defined
as BMI <18.5). Low BMI is a powerful and independent predictor of
4
mortality after the start of ART , and significant weight loss in HIV positive
individuals is associated with increased risk of opportunistic infection,
5
complications, and early mortality .

Acute malnutrition requires life-saving medical attention. Consistent with

the 2007 joint UN statement on the "Community Based Management of
Acute Malnutrition (CMAM)," the government of Zimbabwe has adopted
CMAM as its primary strategy for managing acute malnutrition. CMAM aims
to treat uncomplicated SAM on an outpatient basis using ready to use
therapeutic foods and clinical protocols, to treat complicated SAM in
inpatient facilities using F-75 and F-100 therapeutic milks and clinical
protocols, and to treat MAM through provision of fortified supplementary
foods and clinical protocols.

Introduction
Malnutrition results from socio-economic and other problems such as poor
water and sanitation, sub-optimal care practices, poor access to nutritious
food, low education and repeated infections, which may also be HIV,
related. Successful management of malnutrition requires that both medical
and social problems be recognized and corrected.

3
Kotlerr DP, 1994, Wasting syndrome: nutritional support in HIV Infection, AIDS
4
Koethe et al., 2009, Macronutrient Supplementation for Malnourished HIV infected Adults: A
Review of the Evidence in Resource Adequate and Resource Constrained Settings, Clinical
Infectious Diseases 2009; 49:787-798
5
Friis H, 2006, Micronutrient Intervention and HIV infection: A Review of Current Evidence,
Tropical Medicine and International Health
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 SECTION 2
CLASSIFICATION OF ACUTE MALNUTRITION

Acute malnutrition can be classified as either moderate or severe using

several different indices. The table below represents Zimbabwe specific cut-
offs for classifying acute malnutrition, by Age and Index.

Classification
Measurement
Age Group Severe Acute Moderate Acute
Index
Malnutrition Malnutrition
Classify severe if presence of any of the following:
 Bilateral pitting oedema
Children Less
 Weight for Length <-3 SD (WHO)
than 6
 Infant too weak or feeble to suckle effectively
Months
 Mother reports breastfeeding failure AND infant is not gaining
weight at home
Classification of Acute Malnutrition

Weight for Height (W/H) <-3 SD (WHO) <-2 & ≥-3 SD (WHO)
Children 6 to Mid-upper Arm
<115 mm <125 & ≥ 115 mm
59 Months Circumference (MUAC)
Bilateral Pitting Oedema Yes No
Children and Body Mass Index (BMI) <-3 SD (WHO) OR
<-2 & ≥-3 SD (WHO)
Adolescents for Age visible wasting
(6 to 18
Bilateral pitting oedema Yes No
Years )
Adults Body Mass Index (BMI) <16 kg/m2 <18.5 & ≥16 kg/m2
(Above 18
Bilateral pitting oedema Yes No
Years)
Pregnant or Mid-upper Arm
<190 mm <230mm & ≥190mm
Lactating Circumference (MUAC)
Women (Any
Bilateral pitting oedema Yes No
Age)

Section 5 of this reference guide contains look up tables to assist in the

classification of individual patients. There are separate look up tables for
boys and girls (Weight for height), adolescents (BMI for age), and adults
(BMI) – it is critical that providers use the appropriate age/sex specific table
in classifying patients.

For adolescents, you must calculate BMI prior to referring to the BMI for
Age Table.

Calculation of BMI for Adolescents and Adults

Measured Weight (kg)

Height (x) Height (m)

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 SECTION 3
FEEDING FORMULAS FOR MALNOURISHED INDIVIDUALS

What is F-75?
F-75, Formula 75, is used during the first phase in the management of of
complicated severe acute malnutrition. F-75 is administered until the
patient has fully stabilized, which typically takes between 2 and 7 days.
Severely malnourished patients with complications have difficulty tolerating
protein, sodium, or high amounts of fat – introduction of these nutrients in
incorrect proportions may lead to death. F-75 is specially formulated to
meet the malnourished patient’s needs without overwhelming the body's
systems during the initial stage of treatment. F-75 contains 75 kcal and 0.9 g
protein per 100 ml.

F-75 should never be administered on an outpatient basis.

What is F-100?
F-100, Formula 100, is introduced after the patient is stabilized and is
intended to rebuild wasted tissues as quickly as possible during the “rapid

Feeding Formulas
recovery” phase. Like F-75, F-100 is specially formulated to provide the the
appropriate mix of nutrients as the patient recovers. F-100 contains more
calories and protein than F-75: 100 kcal and 2.9g protein per 100 ml.

F-100 should never be administered on an outpatient basis.

What is RUTF?
RUTF, Ready to Use Therapeutic Food, is made of powdered ingredients
embedded in a lipid rich paste, resulting in an energy dense food that resists
microbial contamination. RUTF is a mixture of milk powder, vegetable oil,
sugar, peanut butter, powdered vitamins and minerals. As the name implies,
RUTF does not require preparation prior to consumption. RUTF has the
same basic formulation as F-100, and is used to support rapid recovery of
uncomplicated severely malnourished patients. While RUTF must be
consumed with water, no other foods are necessary for the rehabilitation of
the malnourished child. RUTF can be safely stored at ambient temperatures
for up to 24.

RUTF can be administered on an outpatient basis.

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 What is CSB Plus?
CSB Plus is a dried blended food consisting of heat treated maize, soya
beans, sugar, vitamins, and minerals. The product is typically prepared in the
home as a porridge or gruel using boiled water. The most common
preparation uses 1 part of CSB Plus to 5 parts water. CSB Plus is prescribed
to recently recovered severely malnourished patients and to patients over
the age of 2 years with moderate acute malnutrition.
CSB Plus should be provided as a take-home ration.

What is CSB Plus Plus?

CSB Plus Plus is a dried blended food prepared from heat treated maize and
de-hulled soya beans, sugar, dried skim milk, refined soya bean oil, vitamins
and minerals. The product is typically prepared in the home as a porridge or
gruel using boiled water. CSB Plus Plus is prescribed for children between 6
and 24 months of age.

The product is to be used as a complement to breastfeeding in the home -

Feeding Formulas

the product should NOT be used as a breast-milk substitute.

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 SECTION 4
ADMISSION CRITERIA FOR MANAGEMENT OF ACUTE MALNUTRITION

INFANTS (LESS THAN 6 MONTHS OF AGE)

Bilateral pitting oedema any grade

OR
DIAGNOSIS

Weight for Length <-3 SD (WHO)

OR
Infant too weak or feeble to suckle effectively
OR
Mother reports breastfeeding failure AND infant is not gaining weight at home

 Admit to Stabilization care


ACTION

Give dilute F-100 (DF-100)

 Manage according IMNCI protocols

Provide health and nutrition counseling and continued follow up

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Admission Criteria
 Admission Criteria

CHILDREN (6 TO 59 MONTHS OF AGE)

WITH COMPLICATIONS WITHOUT COMPLICATIONS
Bilateral Pitting Oedema (any grade) Bilateral Pitting Oedema (grade one or two) Weight for height
OR OR <-2SD & ≥ – 3 SD (WHO)
Weight for height <-2 SD (WHO) Weight for Height < -3SD (WHO) OR
OR OR MUAC <125mm & ≥115mm
MUAC < 125mm MUAC < 115mm
OR
MUAC <125mm and HIV positive
DIAGNOSIS

AND
AND AND
ANY of the following:
 Anorexia (no appetite) ALL of the following: ALL of the following:
 Lower respiratory tract infection
 Fever (>39° C)  Appetite  Appetite
 Severe dehydration  Clinically well  Clinically well
 Severe anemia  Alert  Alert
 Hypoglycemia
 Hypothermia (<35° C)
 Not alert
INPATIENT CARE OUTPATIENT CARE SUPPLEMENTARY FEEDING
 Give F-75 in Phase I  Give RUTF  Give CSB Plus Plus to children between 6
 Give F-100/RUTF in Phase II  Give routine medicines and 24 months of age
ACTION

 Give routine medicines  Give CSB Plus to children over the age of
24 months
 Give routine medicines

Provide health and nutrition counseling and continued follow up

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 CHILDREN AND ADOLESCENTS (6 TO 18 YEARS OF AGE)
WITH COMPLICATIONS WITHOUT COMPLICATIONS
Bilateral pitting oedama (any grade) Bilateral pitting oedema (grade one or BMI for AGE <-2 SD & ≥-3 SD (WHO)
OR two)
BMI for AGE <-3 SD (WHO) OR
BMI for AGE <-3 SD (WHO)

AND AND AND

DIAGNOSES

ANY of the following: ALL of the following: ALL of the following:

 Anorexia
 Respiratory tract infections  Appetite  No bilateral pitting oedema
 Fever  Clinically well  Appetite
 Severe dehydration  Alert  Clinically well
 Severe anemia  Alert
 Hypoglycemia
 Hypothermia
 Not alert
INPATIENT CARE OUTPATIENT CARE SUPPLEMENTARY FEEDING
 Give F75 in Phase I  Give RUTF  Give CSB Plus
ACTION

 Give F 100/RUTF in Phase II  Give routine medicines  Give routine medicines

 Give routine medicines
Provide health and nutrition counseling and continued follow up

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Admission Criteria
 Admission Criteria

ADULTS (ABOVE 18 YEARS OF AGE)

WITH COMPLICATIONS WITHOUT COMPLICATIONS
Adults Adults Adults
Bilateral pitting oedema (any grade) Bilateral pitting oedema (grade one or two) BMI <18.5 kg/m2 & ≥16 kg/m2 and
OR OR
BMI <16 kg/m2 BMI <16 kg/m2

Pregnant & lactating women
Bilateral pitting oedema (any grade)
OR
MUAC < 190mm with weight loss in past 4
DIAGNOSES
Pregnant & Lactating women Pregnant & Lactating women
Bilateral pitting oedema (grade one or two) MUAC <230mm & ≥190mm
OR
MUAC < 190mm with NO weight loss in past 4

weeks weeks
AND
AND AND
Complications which affect food intake, in ALL of the following:
addition to: ALL of the following:
 Anorexia  No bilateral pitting oedema
 Lower Respiratory tract infections  Appetite  Appetite
 Fever  Clinically well  Clinically well
 Severe dehydration  Alert  Alert
 Severe anaemia
 Hypoglycemia
 Hypothermia
 Not alert
INPATIENT CARE OUTPATIENT CARE SUPPLEMENTARY FEEDING
 Give F75 in Phase I  Give RUTF  Give CSB Plus
ACTION

 Give F 100/RUTF in Phase II  Giver routine medicines  Give routine medicines

 Give routine medicines
Provide health and nutrition counseling and continued follow up

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 SECTION 4A
INPATIENT THERAPEUTIC CARE (STABILIZATION CARE)

Patients with severe or moderate acute malnutrition AND complications

should be admitted for inpatient care. Complications should be managed
according to national protocols for different age groups.

Inpatient Therapeutic Feeding Recommendations

Phase 1 (Stabilization care)

Age Group Product and Prescription

 Give Diluted F-100 at 130 ml/kg of body weight per day

Children <6
Months  Breastfed children should always be offered breast milk

Inpatient Therapeutic Care

before the therapeutic milk, and always on demand

 Give F-75 at 130 ml/kg of body weight per day until the
patient re-gains appetite.
 Start with 2 hourly feeds (12 feeds per day) and gradually
decrease the frequency of feeding and increase the volume of
Children 6 to
each feed until the patient is receiving 3-hourly feeds (8 feeds
59 Months
per day)
 Breastfed children should always be offered breast milk
before the therapeutic milk, and should always be breastfed
on demand

 For 12 – 14 years give 3.5ml/kg of body weight per hour

Children and (calculate for 24hrs)
Adolescents
(6 to 18)  For 15-18 years give 2.8ml/kg of body weight per hour
(calculate for 24 hrs)

 For 19-75 years give 2.2ml/kg of body weight per hour

Adults (calculate for 24hrs)
(Above 18)  For >75years give 2.0ml/kg of body weight per hour
(calculate for 24 hrs)

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 Transition Phase

Age Group Product and Prescription

All Age  Once stabilized, replace F-75 with F-100. The quantity of
Groups formula provided should remain the same as in Phase 1

Phase 2 (Rapid Recovery)

Age Group Product and Prescription

Children <6  Give twice the volume of formula offered during phase I
Months
Inpatient Therapeutic Care

 Give F-100 at 200ml/kg of body weight per day. Child should

consume a minimum of 150 ml/kg of bodyweight each day
Children 6 to  Gradually introduce RUTF in small amounts until patient can
59 Months consume ¾ of recommended allocation per day
 When accepted, provide RUTF at 200 kcal/ kg of body weight
per day

 For 12 – 14 years give 2.5ml/kg of body weight per hour

(calculate for 24hrs)
Children and
 For 15-18 years give 2.0ml/kg of body weight per hour
Adolescents
(calculate for 24 hrs)
(6 to 18)
Please Note: Individual needs may vary by up to 30 percent from
these recommendations

 For 19-75 years give 1.7ml/kg of body weight per hour

(calculate for 24hrs)
Adults  For >75years give 1.5ml/kg of body weight per hour
(Above 18) (calculate for 24 hrs)
Please Note: Individual needs may vary by up to 30 percent from
these recommendations

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 Discharge Criteria from Inpatient Care, by Age

Age Group Discharge Criteria

 Successful lactation in mother is re-established;

Children <6  Infant achieves 20 grams weight gain per day on breastfeeding
Months alone for 5 days; and
 Infant is clinically well and alert

 Appetite has returned – that is, the patient eats at least 75

percent of allocated RUTF as observed for a period of 24
All Other Age hours; and,
Groups
 Medical complications are resolved or controlled; and,
 Oedema is resolving

 Discharged patients should be referred immediately to outpatient therapeutic

Inpatient Therapeutic Care

care for continued treatment and follow up – discharge with a one week
supply of RUTF
 Children under 6 months of age should NOT receive RUTF. IF breastfeeding is
not possible, provide replacement feeding according to national guidance

Other Exits from Inpatient Care

Status Criteria

Default  Absent for 2 consecutive days

Death  Died during stay in inpatient facility

 In program for 6 weeks without reaching inpatient discharge

Non-Cured
criteria

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 Inpatient Therapeutic Care

Routine Medicines to Accompany Inpatient Therapeutic Care

Length of
Product When Patient Age Prescription Dosage
Treatment
VITAMIN A 1 drops
< 6 months 50,000 IU
(1/4 capsule)
(Do not provide 3 drops Single dose on
vitamin A if child is 6 months to < 1 year 100,000 IU
On Admission (1/2 capsule) admission
readmitted or has
6 drops
received ≥ 1 year (>8kg) 200,000 IU
(1 capsule)
recommended dose
within last 30 days) Do NOT provide Vitamin A to children with Oedema
IRON Do NOT Provide (contained in RUTF). Severe anemia to be treated according to national protocol from wk 3.
Single dose on
FOLIC ACID* On Admission All 5 mg Single dose
admission

On Admission 7 days (or 10 days if

AMOXYCILLIN All weighing >2 Kg Refer to EDLIZ Refer to EDLIZ
(presumptive) needed)

COARTEM On Admission
ARTEMETER (if positive for All weighing ≥ 4kg Refer to EDLIZ Refer to EDLIZ Refer to EDLIZ
LUMEFANTRINE malaria)

On Discharge < 2 years Do NOT Provide

ALBENDAZOLE or from
MEBENDAZOLE Inpatient (Alb) 400 mg
≥ 2 years Single dose Single dose
Care (Meben) 500 mg

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 SECTION 4B
OUTPATIENT THERAPEUTIC CARE

Patients with severe acute malnutrition WITHOUT complications should be

enrolled in the outpatient therapeutic care program.

Assessment of Appetite

Prior to admission, it is critical to assess the patient’s appetite – if the

patient lacks appetite or cannot for some reason consume the RUTF; the
patient should be referred for inpatient care (see Section 4A). Lack of
appetite may indicate poor liver or gastrointestinal function. Furthermore, a
patient with poor appetite may not consume the RUTF per
recommendation.

Assessing Appetite:

Outpatient Therapeutic Care

 Give patient RUTF to try
 The patient may refuse due to the strange environment or strange
product – provide positive encouragement
 If it is a young child the care giver should try feeding in a quiet
place (allow plenty of time)
 The health worker should observe the patient eating RUTF before
admitting to the outpatient program
 Patients who refuse or cannot eat RUTF should be admitted to
inpatient care until appetite is restored.

Outpatient Therapeutic Feeding Recommendations

Patients in the outpatient program should be provided with RUTF in

accordance with recommendations for their age and weight (see table
below). The patient should be provided a one week supply of RUTF at each
visit. Each week, the patient should return to the clinic for follow up and
additional supply of RUTF.

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 Daily Consumption of RUTF, by Age and Weight

Patient Weight RUTF

Age Group
(Kg) Sachet/Day Sachet/Week
Children < 6 Do NOT provide RUTF
months
3.5 – 3.9 1½ 11
4.0 – 5.4 2 14
5.5 – 6.9 2½ 18
Children 6 to
59 Months 7.0 – 8.4 3 21
(200 8.5 – 9.4 3½ 25
kcal/kg/day)
9.5 – 10.4 4 28
10.5 – 11.9 4.5 32
Outpatient Therapeutic Care

<12 5 35
10 -13 1½ 11
14 - 19 2 14

Children and 20 - 21 2½ 18
Adolescents 22 - 28 3 21
(6 to 18 Years)
29 -30 3½ 25
31 - 41 4 28
42 - 48 4½ 32
25 - 28 2 14

Adults 29 - 32 2½ 18
(Above 18 33 - 41 3 21
Years)
42 - 44 3½ 25
44 - 60 4 28
Pregnant or 5 35
Lactating Any weight
Women 6 42

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 How to Give RUTF at Home

It is important to ensure RUTF will be administered appropriately at home.

Please convey the following key messages to the caretaker or patient prior
to discharge:

 RUTF should not be mixed with water or other food - it should be

consumed whole and does not need to be heated;
 The patient should finish the entire allocated daily ration;
 RUTF should be fed in small frequent quantities; and,
 Once tolerating and finishing the daily allocation of RUTF, the patient
should be gradually re-introduced to other family foods.

Discharge criteria from Outpatient Care, by Age

Outpatient Therapeutic Care

Age Group Discharge Criteria
Children < 6
Do NOT provide RUTF
Months
 No bilateral pitting oedema for 2 consecutive assessments;
and,
Children 6 to  Weight for height >-2 SD for 2 consecutive assessments; or,
59 Months  15 percent weight gain in first follow up visit without oedema
(if admitted based on MUAC)
 Clinically well

Children and  No bilateral pitting oedema for 2 consecutive assessments

Adolescents (6  BMI for AGE >-2 SD for 2 consecutive assessments
to 19 Years)
 Clinically well

 No bilateral pitting oedema for 2 consecutive assessments

Adults (Above
 BMI > 16/m2
18 Years)
 Clinically well

Pregnant and  No bilateral pitting oedema for two consecutive visits

Lactating  MUAC > 190 if there is an SFP and infant ≥ 6 months
Women
 Clinically well

 Discharged patients should be referred immediately to the supplementary

feeding program for continued treatment and follow up

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 Other Exits from Outpatient Care

Status Criteria

Default  Absent for 3 consecutive visits

Death  Died during time registered in outpatient care

 Minimum of 4 months if weight is static and all available

Non-Cured
treatment options have been pursued – refer for further care
Outpatient Therapeutic Care

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 Routine Medicines to Accompany Outpatient Therapeutic Care

Length of
Product When Patient Age Prescription Dosage
Treatment
VITAMIN A 3 drops
6 months to < 1 year 100,000 IU
(1/2 capsule) Single dose on
(Do not provide vitamin 6 drops admission
A if child is readmitted On Admission ≥ 1 year (>8kg) 200,000 IU
(1 capsule)
or has received
recommended dose Do NOT provide Vitamin A to children with Oedema
within last 30 days)
IRON Do NOT Provide (contained in RUTF)
Single dose on
FOLIC ACID* On Admission All 5 mg Single dose
admission

On Admission 7 days (or 10 days

AMOXYCILLIN All weighing >2 Kg Refer to EDLIZ Refer to EDLIZ
(presumptive) if needed)

On Admission
COARTEM ARTEMETER
(if positive for All weighing ≥ 4kg Refer to EDLIZ Refer to EDLIZ Refer to EDLIZ
LUMEFANTRINE
malaria)
On Admission < 2 years Do NOT Provide
(if not
ALBENDAZOLE or
provided in (Alb) 400 mg
MEBENDAZOLE ≥ 2 years Single dose Single dose
inpatient (Meb) 500 mg
care)
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Outpatient Therapeutic Care

 SECTION 4C
SUPPLEMENTARY FEEDING

Patients with moderate malnutrition WITHOUT complications should be

admitted to the supplementary feeding program.

Supplementary Feeding Recommendations, by Age

Age Group Commodity Ration Per Ration Per Month

Day (g) (Kg)
Children 6 to 24
months of age CSB Plus Plus 100g 3 Kg

Children 24 to 59
months of age CSB Plus 200g 6 Kg

Children and
CSB Plus 200g 6 Kg
Supplementary Feeding

Adolescents (6 to 18)
years(Above
Adults of age)18
Years) CSB Plus 200g 6 Kg

HIV+ Adults
CSB Plus 250g 7.5 Kg

Pregnant/Lactating
Women CSB Plus 250g 7.5 Kg

 Refer SFP patients to a local food security partner for assessment of

household food security status and possible family ration

Note: Rations may differ between organizations – this is acceptable as long as the
ration allocation meets the recommended minimum quantity per day

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 Discharge Criteria from Supplementary Feeding, by Age

Age Group Discharge Criteria

Weight for Height > -2 SD (WHO) for two consecutive visits

Children 6 to 24
OR
months of age
OR MUAC >125mm for two consecutive visits

Weight for Height > -2 SD (WHO) for two consecutive visits

Children 24 to 59
OR
months of age
OR MUAC >125mm for two consecutive visits

Children and
Adolescents (6 to BMI for Age > -2 SD (WHO) for two consecutive visits

Supplementary Feeding
18 years)

Adults (Above 19
Years)
BMI > 18.5 kg/m2
HIV+ Adults

Pregnant or
MUAC greater than 230 mm
Lactating Women
Provide health and nutrition counseling prior to discharge

Other Exits from Supplementary Feeding

Status Criteria

Default  Absent for 3 consecutive visits

Death  Died during time registered in supplementary feeding program

 Minimum of 6 months if weight is static and all available

Non-Cured
treatment options have been pursued – refer for further care

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 Supplementary Feeding

Routine Medicines to Accompany Supplementary Feeding

Length of
Product When Age of Patient Prescription Dosage
Treatment
VITAMIN A 3 drops
6 months to < 1 year 100,000 IU
(1/2 capsule)
(Do not provide
vitamin A if child is Single dose on
On Admission
readmitted or has 6 drops admission
≥ 1 year (>8kg) 200,000 IU
received (1 capsule)
recommended dose
within last 30 days)
2 Years to 5 Years

IRON/FOLATE On Admission 6 Years to 11 Years Refer to EDLIZ Refer to EDLIZ Refer to EDLIZ

Adults

On Admission < 2 years Do NOT Provide

(if not
ALBENDAZOLE or
provided in (Alb) 400 mg
MEBENDAZOLE ≥ 2 years Single dose Single dose
inpatient (Meben) 500 mg
care)

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 SECTION 5A
LOOK UP TABLES: CHILDREN 6 TO 59 MONTHS OF AGE (Girls)

Weight for Length (Lying) - GIRLS 6 to 59 Months using WHO Standard (Z-Score)
Lenth (cm) -3 SD -2 SD Length (cm) -3 SD -2 SD
55 3.5 3.8 71 6.5 7
55.5 3.6 3.9 71.5 6.5 7.1
56 3.7 4 72 6.6 7.2
56.5 3.8 4.1 72.5 6.7 7.3
57 3.9 4.3 73 6.8 7.4
57.5 4 4.4 73.5 6.9 7.4
58 4.1 4.5 74 6.9 7.5
58.5 4.2 4.6 74.5 7 7.6
59 4.3 4.7 75 7.1 7.7
59.5 4.4 4.8 75.5 7.1 7.8
60 4.5 4.9 76 7.2 7.8
60.5 4.6 5 76.5 7.3 7.9
61 4.7 5.1 77 7.4 8
61.5 4.8 5.2 77.5 7.4 8.1

Look Up Tables
62 4.9 5.3 78 7.5 8.2
62.5 5 5.4 78.5 7.6 8.2
63 5.1 5.5 79 7.7 8.3
63.5 5.2 5.6 79.5 7.7 8.4
64 5.3 5.7 80 7.8 8.5
64.5 5.4 5.8 80.5 7.9 8.6
65 5.5 5.9 81 8 8.7
65.5 5.5 6 81.5 8.1 8.8
66 5.6 6.1 82 8.1 8.8
66.5 5.7 6.2 82.5 8.2 8.9
67 5.8 6.3 83 8.3 9
67.5 5.9 6.4 83.5 8.4 9.1
68 6 6.5 84 8.5 9.2
68.5 6.1 6.6 84.5 8.6 9.3
69 6.1 6.7 85 8.8 9.6
69.5 6.2 6.8 85.5 8.9 9.7
70 6.3 6.9 86 9 9.8
70.5 6.4 6.9 86.5 9.1 9.9

25 | P a g e
 SECTION 5A
LOOK UP TABLES: CHILDREN 6 TO 59 MONTHS OF AGE (Girls)

Weight for Height (Standing) - GIRLS 6 to 59 Months using WHO Standard (Z-Score)
Height (cm) -3 SD -2 SD Height (cm) -3 SD -2 SD
87 9.2 10 101 12 13
87.5 9.3 10.1 101.5 12.1 13.1
88 9.4 10.2 102 12.2 13.3
88.5 9.5 10.3 102.5 12.3 13.4
89 9.6 10.4 103 12.4 13.5
89.5 9.7 10.5 103.5 12.5 13.6
90 9.8 10.6 104 12.6 13.8
90.5 9.9 10.7 104.5 12.8 13.9
91 10 10.9 105 12.9 14
91.5 10.1 11 105.5 13 14.2
92 10.2 11.1 106 13.1 14.3
92.5 10.3 11.2 106.5 13.3 14.5
93 10.4 11.3 107 13.4 14.6
93.5 10.5 11.4 107.5 13.5 14.7
Look Up Tables

94 10.6 11.5 108 13.7 14.9

94.5 10.7 11.6 108.5 13.8 15
95 10.8 11.7 109 13.9 15.2
95.5 10.8 11.8 109.5 14.1 15.4
96 10.9 11.9 110 14.2 15.5
96.5 11 12 110.5 14.4 15.7
97 11.1 12.1 111 14.5 15.8
97.5 11.2 12.2 111.5 14.7 16
98 11.3 12.3 112 14.8 16.2
98.5 11.4 12.4 112.5 15 16.3
99 11.5 12.5 113 15.1 16.5
99.5 11.6 12.7 113.5 15.3 16.7
100 11.7 12.8 114 15.4 16.8
100.5 11.9 12.9 114.5 15.6 17
115 15.7 17.2

26 | P a g e
 SECTION 5A
LOOK UP TABLES: CHILDREN 6 TO 59 MONTHS OF AGE (Boys)

Weight for Length (Lying) - BOYS 6 to 59 Months using WHO Standard (Z-Score)

Lenth (cm) -3 SD -2 SD Length (cm) -3 SD -2 SD

55 3.6 3.8 71 6.8 7.4
55.5 3.7 4 71.5 6.9 7.5
56 3.8 4.1 72 7 7.6
56.5 3.9 4.2 72.5 7.1 7.6
57 4 4.3 73 7.2 7.7
57.5 4.1 4.5 73.5 7.2 7.8
58 4.3 4.6 74 7.3 7.9
58.5 4.4 4.7 74.5 7.4 8
59 4.5 4.8 75 7.5 8.1
59.5 4.6 5 75.5 7.6 8.2
60 4.7 5.1 76 7.6 8.3
60.5 4.8 5.2 76.5 7.7 8.3
61 4.9 5.3 77 7.8 8.4

Look Up Tables
61.5 5 5.4 77.5 7.9 8.5
62 5.1 5.6 78 7.9 8.6
62.5 5.2 5.7 78.5 8 8.7
63 5.3 5.8 79 8.1 8.7
63.5 5.4 5.9 79.5 8.2 8.8
64 5.5 6 80 8.2 8.9
64.5 5.6 6.1 80.5 8.3 9
65 5.7 6.2 81 8.4 9.1
65.5 5.8 6.3 81.5 8.5 9.1
66 5.9 6.4 82 8.5 9.2
66.5 6 6.5 82.5 8.6 9.3
67 6.1 6.6 83 8.7 9.4
67.5 6.2 6.7 83.5 8.8 9.5
68 6.3 6.8 84 8.9 9.6
68.5 6.4 6.9 84.5 9 9.7
69 6.5 7 85 9.2 10
69.5 6.6 7.1 85.5 9.3 10.1
70 6.6 7.2 86 9.4 10.2
70.5 6.7 7.3 86.5 9.5 10.3

27 | P a g e
 SECTION 5A
LOOK UP TABLES: CHILDREN 6 TO 59 MONTHS OF AGE (Boys)

Weight for Height (Standing) - BOYS 6 to 59 Months using WHO Standard (Z-Score)

Height (cm) -3 SD -2 SD Height (cm) -3 SD -2 SD

87 9.6 10.4 101 12.3 13.3
87.5 9.7 10.5 101.5 12.4 13.4
88 9.8 10.6 102 12.5 13.6
88.5 9.9 10.7 102.5 12.6 13.7
89 10 10.8 103 12.8 13.8
89.5 10.1 10.9 103.5 12.9 13.9
90 10.2 11 104 13 14
90.5 10.3 11.1 104.5 13.1 14.2
91 10.4 11.2 105 13.2 14.3
91.5 10.5 11.3 105.5 13.3 14.4
92 10.6 11.4 106 13.4 14.5
92.5 10.7 11.5 106.5 13.5 14.7
93 10.8 11.6 107 13.7 14.8
93.5 10.9 11.7 107.5 13.8 14.9
Look Up Tables

94 11 11.8 108 13.9 15.1

94.5 11.1 11.9 108.5 14 15.2
95 11.1 12 109 14.1 15.3
95.5 11.2 12.1 109.5 14.3 15.5
96 11.3 12.2 110 14.4 15.6
96.5 11.4 12.3 110.5 14.5 15.8
97 11.5 12.4 111 14.6 15.9
97.5 11.6 12.5 111.5 14.8 16
98 11.7 12.6 112 14.9 16.2
98.5 11.8 12.8 112.5 15 16.3
99 11.9 12.9 113 15.2 16.5
99.5 12 13 113.5 15.3 16.6
100 12.1 13.1 114 15.4 16.8
100.5 12.2 13.2 114.5 15.6 16.9
115 15.7 17.1

28 | P a g e
 SECTION 5B
LOOK UP TABLES: CHILDREN & ADOLESCENTS 6 TO 18 YEARS OF AGE

BMI for AGE - GIRLS 6 to 18 years using WHO Standard (z-score)

Year: Year:
Month Month -3 SD -2 SD Month Months -3 SD -2 SD
5:1 61 11.8 12.7 8:6 102 12 13
5:2 62 11.8 12.7 8:7 103 12 13
5:3 63 11.8 12.7 8:8 104 12 13.1
5:4 64 11.8 12.7 8:9 105 12.1 13.1
5:5 65 11.7 12.7 8:10 106 12.1 13.1
5:6 66 11.7 12.7 8:11 107 12.1 13.1
5:7 67 11.7 12.7 9:0 108 12.1 13.2
5:8 68 11.7 12.7 9:1 109 12.1 13.2
5:9 69 11.7 12.7 9:2 110 12.2 13.2
5:10 70 11.7 12.7 9:3 111 12.2 13.2
5:11 71 11.7 12.7 9:4 112 12.2 13.3
6:0 72 11.7 12.7 9:5 113 12.2 13.3
6:1 73 11.7 12.7 9:6 114 12.3 13.3
6:2 74 11.7 12.7 9:7 115 12.3 13.4
6:3 75 11.7 12.7 9:8 116 12.3 13.4
6:4 76 11.7 12.7 9:9 117 12.3 13.4

Look Up Tables
6:5 77 11.7 12.7 9:10 118 12.4 13.4
6:6 78 11.7 12.7 9:11 119 12.4 13.5
6:7 79 11.7 12.7 10:0 120 12.4 13.5
6:8 80 11.7 12.7 10:1 121 12.4 13.5
6:9 81 11.7 12.7 10:2 122 12.5 13.6
6:10 82 11.7 12.7 10:3 123 12.5 13.6
6:11 83 11.8 12.7 10:4 124 12.5 13.6
7:0 84 11.8 12.7 10:5 125 12.5 13.7
7:1 85 11.8 12.8 10:6 126 12.6 13.7
7:2 86 11.8 12.8 10:7 127 12.6 13.7
7:3 87 11.8 12.8 10:8 128 12.6 13.8
7:4 88 11.8 12.8 10:9 129 12.7 13.8
7:5 89 11.8 12.8 10:10 130 12.7 13.8
7:6 90 11.8 12.8 10:11 131 12.7 13.9
7:7 91 11.8 12.8 11:0 132 12.8 14
7:8 92 11.8 12.8 11:1 133 12.8 14
7:9 93 11.9 12.9 11:2 134 12.9 14
7:10 94 11.9 12.9 11:3 135 12.9 14.1
7:11 95 11.9 12.9 11:4 136 12.9 14.1
8:0 96 11.9 12.9 11:5 137 13 14.2
8:1 97 11.9 12.9 11:6 138 13 14.2
8:2 98 11.9 12.9 11:7 139 13 14.3
8:3 99 12 13 11:8 140 13.1 14.3
8:4 100 12 13 11:9 141 13.1 14.3
8:5 101 12 13 11:10 142 13.2 14.4

SECTION 5B
29 | P a g e
 SECTION 5B
LOOK UP TABLES: CHILDREN & ADOLESCENTS 6 TO 18 YEARS OF AGE

BMI for AGE - GIRLS 5 to 19 years using WHO Standard (z-score)

Year: Year:
month Month -3 SD -2 SD Month Month -3 SD -2 SD
11:11 143 13.1 14.3 15:6 186 14.5 16
12:0 144 13.2 14.4 15:7 187 14.5 16.1
12:1 145 13.2 14.4 15:8 188 14.5 16.1
12:2 146 13.2 14.5 15:9 189 14.5 16.1
12:3 147 13.3 14.5 15:10 190 14.6 16.1
12:4 148 13.3 14.6 15:11 191 14.6 16.2
12:5 149 13.3 14.6 16:0 192 14.6 16.2
12:6 150 13.4 14.7 16:1 193 14.6 16.2
12:7 151 13.4 14.7 16:2 194 14.6 16.2
12:8 152 13.5 14.8 16:3 195 14.6 16.2
12:9 153 13.5 14.8 16:4 196 14.6 16.2
12:10 154 13.5 14.8 16:5 197 14.6 16.3
12:11 155 13.6 14.9 16:6 198 14.7 16.3
13:0 156 13.6 14.9 16:7 199 14.7 16.3
13:1 157 13.6 15 16:8 200 14.7 16.3
13:2 158 13.7 15 16:9 201 14.7 16.3
Look Up Tables

13:3 159 13.7 15.1 16:10 202 14.7 16.3

13:4 160 13.8 15.1 16:11 203 14.7 16.3
13:5 161 13.8 15.2 17:0 204 14.7 16.4
13:6 162 13.8 15.2 17:1 205 14.7 16.4
13:7 163 13.9 15.2 17:2 206 14.7 16.4
13:8 164 13.9 15.3 17:3 207 14.7 16.4
13:9 165 13.9 15.3 17:4 208 14.7 16.4
13:10 166 14 15.4 17:5 209 14.7 16.4
13:11 167 14 15.4 17:6 210 14.7 16.4
14:0 168 14 15.4 17:7 211 14.7 16.4
14:1 169 14.1 15.5 17:8 212 14.7 16.4
14:2 170 14.1 15.5 17:9 213 14.7 16.4
14:3 171 14.1 15.6 17:10 214 14.7 16.4
14:4 172 14.1 15.6 17:11 215 14.7 16.4
14:5 173 14.2 15.6 18:0 216 14.7 16.4
14:6 174 14.2 15.7 18:1 217 14.7 16.5
14:7 175 14.2 15.7 18:2 218 14.7 16.5
14:8 176 14.3 15.7 18:3 219 14.7 16.5
14:9 177 14.3 15.8 18:4 220 14.7 16.5
14:10 178 14.3 15.8 18:5 221 14.7 16.5
14:11 179 14.3 15.8 18:6 222 14.7 16.5
15:0 180 14.4 15.9 18:7 223 14.7 16.5
15:1 181 14.4 15.9 18:8 224 14.7 16.5
15:2 182 14.4 15.9 18:9 225 14.7 16.5
15:3 183 14.4 16 18:10 226 14.7 16.5
15:4 184 14.5 16 18:11 227 14.7 16.5
15:5 185 14.5 16 19:0 228 14.7 16.5

30 | P a g e
 SECTION 5B
LOOK UP TABLES: CHILDREN & ADOLESCENTS 6 TO 18 YEARS OF AGE

BMI for AGE - BOYS 5 to 19 years using WHO Standard (z-score)

Year: Year:
Month Month -3 SD -2 SD Month Month -3 SD -2 SD
5:1 61 12.1 13.0 8:6 102 12.5 13.4
5:2 62 12.1 13.0 8:7 103 12.5 13.4
5:3 63 12.1 13.0 8:8 104 12.5 13.4
5:4 64 12.1 13.0 8:9 105 12.5 13.4
5:5 65 12.1 13.0 8:10 106 12.5 13.5
5:6 66 12.1 13.0 8:11 107 12.5 13.5
5:7 67 12.1 13.0 9:0 108 12.6 13.5
5:8 68 12.1 13.0 9:1 109 12.6 13.5
5:9 69 12.1 13.0 9:2 110 12.6 13.5
5:10 70 12.1 13.0 9:3 111 12.6 13.5
5:11 71 12.1 13.0 9:4 112 12.6 13.6
6:0 72 12.1 13.0 9:5 113 12.6 13.6
6:1 73 12.1 13.0 9:6 114 12.7 13.6
6:2 74 12.2 13.1 9:7 115 12.7 13.6
6:3 75 12.2 13.1 9:8 116 12.7 13.6
6:4 76 12.2 13.1 9:9 117 12.7 13.7

Look Up Tables
6:5 77 12.2 13.1 9:10 118 12.7 13.7
6:6 78 12.2 13.1 9:11 119 12.8 13.7
6:7 79 12.2 13.1 10:0 120 12.8 13.7
6:8 80 12.2 13.1 10:1 121 12.8 13.8
6:9 81 12.2 13.1 10:2 122 12.8 13.8
6:10 82 12.2 13.1 10:3 123 12.8 13.8
6:11 83 12.2 13.1 10:4 124 12.9 13.8
7:0 84 12.3 13.1 10:5 125 12.9 13.9
7:1 85 12.3 13.2 10:6 126 12.9 13.9
7:2 86 12.3 13.2 10:7 127 12.9 13.9
7:3 87 12.3 13.2 10:8 128 13.0 13.9
7:4 88 12.3 13.2 10:9 129 13.0 14
7:5 89 12.3 13.2 10:10 130 13.0 14
7:6 90 12.3 13.2 10:11 131 13.0 14
7:7 91 12.3 13.2 11:0 132 13.1 14.1
7:8 92 12.3 13.2 11:1 133 13.1 14.1
7:9 93 12.4 13.3 11:2 134 13.1 14.1
7:10 94 12.4 13.3 11:3 135 13.1 14.1
7:11 95 12.4 13.3 11:4 136 13.2 14.2
8:0 96 12.4 13.3 11:5 137 13.2 14.2
8:1 97 12.4 13.3 11:6 138 13.2 14.2
8:2 98 12.4 13.3 11:7 139 13.2 14.3
8:3 99 12.4 13.3 11:8 140 13.3 14.3
8:4 100 12.4 13.4 11:9 141 13.3 14.3
8:5 101 12.5 13.4 11:10 142 13.3 14.4

31 | P a g e
 SECTION 5B
LOOK UP TABLES: CHILDREN & ADOLESCENTS 6 TO 18 YEARS OF AGE

BMI for AGE - BOYS 5 to 19 years using WHO Standard (z-score)

Year: Year:
Month Month -3 SD -2 SD Month Month -3 SD -2 SD
11:11 143 13.4 14.4 15:6 186 14.9 16.3
12:0 144 13.4 14.5 15:7 187 15 16.3
12:1 145 13.4 14.5 15:8 188 15 16.3
12:2 146 13.5 14.5 15:9 189 15 16.4
12:3 147 13.5 14.6 15:10 190 15 16.4
12:4 148 13.5 14.6 15:11 191 15.1 16.5
12:5 149 13.6 14.6 16:0 192 15.1 16.5
12:6 150 13.6 14.7 16:1 193 15.1 16.5
12:7 151 13.6 14.7 16:2 194 15.2 16.6
12:8 152 13.7 14.8 16:3 195 15.2 16.6
12:9 153 13.7 14.8 16:4 196 15.2 16.7
12:10 154 13.7 14.8 16:5 197 15.3 16.7
12:11 155 13.8 14.9 16:6 198 15.3 16.7
13:0 156 13.8 14.9 16:7 199 15.3 16.8
13:1 157 13.8 15 16:8 200 15.3 16.8
13:2 158 13.9 15 16:9 201 15.4 16.8
Look Up Tables

13:3 159 13.9 15.1 16:10 202 15.4 16.9

13:4 160 14 15.1 16:11 203 15.4 16.9
13:5 161 14 15.2 17:0 204 15.4 16.9
13:6 162 14 15.2 17:1 205 15.5 17
13:7 163 14.1 15.2 17:2 206 15.5 17
13:8 164 14.1 15.3 17:3 207 15.5 17
13:9 165 14.1 15.3 17:4 208 15.5 17.1
13:10 166 14.2 15.4 17:5 209 15.6 17.1
13:11 167 14.2 15.4 17:6 210 15.6 17.1
14:0 168 14.3 15.5 17:7 211 15.6 17.1
14:1 169 14.3 15.5 17:8 212 15.6 17.2
14:2 170 14.3 15.6 17:9 213 15.6 17.2
14:3 171 14.4 15.6 17:10 214 15.7 17.2
14:4 172 14.4 15.7 17:11 215 15.7 17.3
14:5 173 14.5 15.7 18:0 216 15.7 17.3
14:6 174 14.5 15.7 18:1 217 15.7 17.3
14:7 175 14.5 15.8 18:2 218 15.7 17.3
14:8 176 14.6 15.8 18:3 219 15.7 17.4
14:9 177 14.6 15.9 18:4 220 15.8 17.4
14:10 178 14.6 15.9 18:5 221 15.8 17.4
14:11 179 14.7 16 18:6 222 15.8 17.4
15:0 180 14.7 16 18:7 223 15.8 17.5
15:1 181 14.7 16.1 18:8 224 15.8 17.5
15:2 182 14.8 16.1 18:9 225 15.8 17.5
15:3 183 14.8 16.1 18:10 226 15.8 17.5
15:4 184 14.8 16.2 18:11 227 15.8 17.5
15:5 185 14.9 16.2 19:0 228 15.9 17.6

32 | P a g e
 SECTION 5C
LOOK UP TABLES: ADULT BMI

Height (m) BMI for 18 years and above

Severe malnutrition Moderate
16 15.5 15 14.5 14 13 12 17.5malnutrition
17 16.5
1.4 31.4 30.4 29.4 28.4 27.4 25.5 23.5 34.3 33.3 32.3
1.41 31.8 30.8 29.8 28.8 27.8 25.8 23.9 34.8 33.8 32.8
1.42 32.3 31.3 30.2 29.2 28.2 26.2 24.2 35.3 34.3 33.3
1.43 32.7 31.7 30.7 29.7 28.6 26.6 24.5 35.8 34.8 33.7
1.44 33.2 32.1 31.1 30.1 29.0 27.0 24.9 36.3 35.3 34.2
1.45 33.6 32.6 31.5 30.5 29.4 27.3 25.2 36.8 35.7 34.7
1.46 34.1 33.0 32.0 30.9 29.8 27.7 25.6 37.3 36.2 35.2
1.47 34.6 33.5 32.4 31.3 30.3 28.1 25.9 37.8 36.7 35.7
1.48 35.0 34.0 32.9 31.8 30.7 28.5 26.3 38.3 37.2 36.1
1.49 35.5 34.4 33.3 32.2 31.1 28.9 26.6 38.9 37.7 36.6
1.5 36.0 34.9 33.8 32.6 31.5 29.3 27.0 39.4 38.3 37.1
1.51 36.5 35.3 34.2 33.1 31.9 29.6 27.4 39.9 38.8 37.6
1.52 37.0 35.8 34.7 33.5 32.3 30.0 27.7 40.4 39.3 38.1
1.53 37.5 36.3 35.1 33.9 32.8 30.4 28.1 41.0 39.8 38.6
1.54 37.9 36.8 35.6 34.4 33.2 30.8 28.5 41.5 40.3 39.1
1.55 38.4 37.2 36.0 34.8 33.6 31.2 28.8 42.0 40.8 39.6

Look Up Tables
1.56 38.9 37.7 36.5 35.3 34.1 31.6 29.2 42.6 41.4 40.2
1.57 39.4 38.2 37.0 35.7 34.5 32.0 29.6 43.1 41.9 40.7
1.58 39.9 38.7 37.4 36.2 34.9 32.5 30.0 43.7 42.4 41.2
1.59 40.4 39.2 37.9 36.7 35.4 32.9 30.3 44.2 43.0 41.7
1.6 41.0 39.7 38.4 37.1 35.8 33.3 30.7 44.8 43.5 42.2
1.61 41.5 40.2 38.9 37.6 36.3 33.7 31.1 45.4 44.1 42.8
1.62 42.0 40.7 39.4 38.1 36.7 34.1 31.5 45.9 44.6 43.3
1.63 42.5 41.2 39.9 38.5 37.2 34.5 31.9 46.5 45.2 43.8
1.64 43.0 41.7 40.3 39.0 37.7 35.0 32.3 47.1 45.7 44.4
1.65 43.6 42.2 40.8 39.5 38.1 35.4 32.7 47.6 46.3 44.9
1.66 44.1 42.7 41.3 40.0 38.6 35.8 33.1 48.2 46.8 45.5
1.67 44.6 43.2 41.8 40.4 39.0 36.3 33.5 48.8 47.4 46.0
1.68 45.2 43.7 42.3 40.9 39.5 36.7 33.9 49.4 48.0 46.6
1.69 45.7 44.3 42.8 41.4 40.0 37.1 34.3 50.0 48.6 47.1
1.7 46.2 44.8 43.4 41.9 40.5 37.6 34.7 50.6 49.1 47.7
1.71 46.8 45.3 43.9 42.4 40.9 38.0 35.1 51.2 49.7 48.2
1.72 47.3 45.9 44.4 42.9 41.4 38.5 35.5 51.8 50.3 48.8
1.73 47.9 46.4 44.9 43.4 41.9 38.9 35.9 52.4 50.9 49.4
1.74 48.4 46.9 45.4 43.9 42.4 39.4 36.3 53.0 51.5 50.0
1.75 49.0 47.5 45.9 44.4 42.9 39.8 36.8 53.6 52.1 50.5
1.76 49.6 48.0 46.5 44.9 43.4 40.3 37.2 54.2 52.7 51.1
1.77 50.1 48.6 47.0 45.4 43.9 40.7 37.6 54.8 53.3 51.7
1.78 50.7 49.1 47.5 45.9 44.4 41.2 38.0 55.4 53.9 52.3
1.79 51.3 49.7 48.1 46.5 44.9 41.7 38.4 56.1 54.5 52.9
1.8 51.8 50.2 48.6 47.0 45.4 42.1 38.9 56.7 55.1 53.5
1.81 52.4 50.8 49.1 47.5 45.9 42.6 39.3 57.3 55.7 54.1

33 | P a g e
 SECTION 5C
LOOK UP TABLES: ADULT BMI

Height (m) BMI for 18 years and above

Severe malnutrition Moderate
1.82 53.0 51.3 49.7 48.0 46.4 43.1 39.7 58.0malnutrition
56.3 54.7
1.83 53.6 51.9 50.2 48.6 46.9 43.5 40.2 58.6 56.9 55.3
1.84 54.2 52.5 50.8 49.1 47.4 44.0 40.6 59.2 57.6 55.9
1.85 54.8 53.0 51.3 49.6 47.9 44.5 41.1 59.9 58.2 56.5
1.86 55.4 53.6 51.9 50.2 48.4 45.0 41.5 60.5 58.8 57.1
1.87 56.0 54.2 52.5 50.7 49.0 45.5 42.0 61.2 59.4 57.7
1.88 56.6 54.8 53.0 51.2 49.5 45.9 42.4 61.9 60.1 58.3
1.89 57.2 55.4 53.6 51.8 50.0 46.4 42.9 62.5 60.7 58.9
1.9 57.8 56.0 54.2 52.3 50.5 46.9 43.3 63.2 61.4 59.6
Look Up Tables

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 SECTION 5D
LOOK UP TABLES: 15% Percent Weight Change (for MUAC Admissions)

Look Up Tables

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