Orientation in PIMAM

ACUTE MALNUTRITION (EASTERN SAMAR)
PHILIPPINE INTEGRATED MANAGEMENT OF Orientation in

PHILIPPINE
INTEGRATED
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
ALMASIR M. JUMAHARI, RND
Nutritionist-Dietitian II (PDOH-E. Samar)
PHILIPPINE INTEGRATED MANAGEMENT OF
Objectives:
At the end of the session, participants are

able to:
• Know the Nutrition Situation of under 5 in
Eastern Samar.
• Identify the Acute Malnutrition.
• Learn how manage Acute Malnutrition.
• Learn the Criteria for Admission &
Discharge.
Orientation in
PHILIPPINE INTEGRATED
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Basic Principles
Each child has the right to food, health and care
to enable optimum potential.
Lack of food, health and care are risk factors

for malnutrition.
MALNUTRITION is strongly linked with

DEATH.
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Acute Malnutrition in the Philippines
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Nutrition Situation in E. Samar
UNDERWEIGHT STUNTING WASTING OBESE/OVERWEIGHT
17.00% 16.71%
15.00% 14.40% 14.71%
13.00%
11.00%
9.00%
7.00% 6.51% 6.78%

6.00%
5.80% 5.39% 6.44%
5.00%
3.60% 3.39%
3.04%
3.00%
1.00%
2021 2022 2023

UNDERWEIGHT 6.00% 6.51% 6.78%
STUNTING 14.40% 14.71% 16.71% Orientation in
WASTING 3.60% 3.04% 3.39% PHILIPPINE INTEGRATED
MANAGEMENT OF
OBESE/OVERWEIGHT 5.80% 5.39% 6.44% ACUTE MALNUTRITION
(PIMAM)
Situation Report of WASTING
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Philippine Integrated Management of
Acute Malnutrition (PIMAM)
MODERATE ACUTE
MALNUTRITION (MAM) + SEVERE ACUTE
MALNUTRITION (SAM)
WFH/L-Z Score: -3SD to <-2SD (CGS) WFH/L-Z Score: <-3SD (CGS)

MUAC (6-59 mos): 11.5cm to 12.4cm MUAC (6-59 mos): <11.5cm
EDEMA(6-59 mos): No Bilateral Pitting Edema EDEMA(6-59 mos): +1, +2 & +3
=
GLOBAL ACUTE MALNUTRITION
(GAM)
The sum of the prevalence of SAM &

MAM at population level. Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
MODERATE ACUTE
MALNUTRITION (MAM)
Moderate Wasting (THIN)
No Nutritional Edema
Children with MAM are 3-4 times

more likely to die than well
nourished kids
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
MODERATE ACUTE
MALNUTRITION (SAM)

=
(GAM)

MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
SEVERE ACUTE
MALNUTRITION (SAM)
MARASMUS KWASHIORKOR
Marasmus:
Severe Wasting
Kwashiorkor:
Presence of Nutritional Edema
Children with SAM are 9-12

times more likely to die than well
nourished kids.
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
MODERATE ACUTE
MALNUTRITION (SAM)

=
(GAM)

MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
IDENTIFICATION OF ACUTE
MALNUTRITION
EDEMA CHECK
Outpatient Therapeutic Care (OTC) Inpatient Therapeutic Care (ITC)
N
U
T
R
ANTHROPOMETRY I
(MUAC)
T Good Appetite or Poor Appetite or
I +1, +2 Edema or +3 Edema or
No Complications W/ Complications
O
N
A Appetite Test &
L SAM Medical
Assessment
ANTHROPOMETRY
(WFL/H-Z Score) S
T
MAM Supplementary Feeding Program (SFP)
A
T
U Orientation in
WELL NOURISHED PHILIPPINE INTEGRATED
S CHILD Counseling/Community Mobilization MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
MALNUTRITION
EDEMA CHECK
STEP 1 STEP 2
Apply normal thumb If there is still an imprint a few
pressure and press down on seconds after you have removed your
top of your child’s feet for thumbs, your child may have severe
three seconds. acute malnutrition so you should go
to the health center as soon as
possible.
You must test for Edema with

finger pressure. You cannot tell
by just looking.
+2 +3
+1 Both Feet, Both Feet,
Both Feet Legs, Hands, Legs, Hands,
Arms Arms, Face Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
MALNUTRITION
EDEMA CHECK
N
U
T
R
ANTHROPOMETRY I
(MUAC)
O
N
A Appetite Test &
L SAM Medical
Assessment
ANTHROPOMETRY
(WFL/H-Z Score) S
T
A
T
U Orientation in
ACUTE MALNUTRITION
(PIMAM)
MALNUTRITION
ANTHROPOMETRY
(MUAC)
STEP 1 STEP 2
Remember to always measure With the arm hanging down relaxed
from behind using the left arm. at the side of the body, tighten the
Estimate the midpoint between tape with enough tension so the tape
the shoulder and elbow through is held against the skin without
the following steps: pinching (1). If the tape is too tight,
1. Palpate the tip of the left the skin will be pinched (2). If the
shoulder tape is too loose, the tape will not be
COLOR MEASUREMENT
2. Palpate the tip of the bent MID-UPPER ARM touching the skin (3). Both 2 & 3 can
elbow CIRCUMFERENCE
cause inaccurate measurements.
3. Measure the distance between RED <11.5cm
*Measured in children from
these two landmarks. than 6 to 59 months of age. 1 2 3
4. Divide this measurement by 2. *A simple measure of muscle YELLOW 11.5-12.4cm
5. This is the midpoint of the left wasting.
upper arm. *An independent measure of GREEN ≥12.5cm
6. Assistant marks the spot. SAM. STEP 3
*Strongly predicts risk of
dying from SAM. Read the color in the
Reminders after taking window between the Orientation in
MUAC: two arrows to identify PHILIPPINE INTEGRATED
*DISINFECT the MUAC the nutritional status
MANAGEMENT OF
ACUTE MALNUTRITION
Tapes. *WASH HANDS of your child. (PIMAM)
Properly after taking MUAC.
MALNUTRITION
EDEMA CHECK
N
U
T
R
ANTHROPOMETRY I
(MUAC)
O
N
A Appetite Test &
L SAM Medical
Assessment
ANTHROPOMETRY
(WFL/H-Z Score) S
T
A
T
U Orientation in
ACUTE MALNUTRITION
(PIMAM)
MALNUTRITION
Measuring WEIGHT ANTHROPOMETRY
(WFL/H-Z Score)
*Have the child remove their shoes and
heavy clothing.
*Have the child sit as still as possible.
*Hang the weighing scale securely
from a tree branch, ceiling beam or pole.
*Attach empty weighing pants to the
hook of the weighing scale. Adjust the
scale to zero, and then remove from the
scale. WFL/H (Z-Score)
*Check if the face or dial of the *Method to assess growth
weighing scale is at eye level, not lower based on Weight & Height/
Length.
or on the higher level.
*Cannot detect
*Put the measurer’s hands through leg Micronutrient Malnutrition.
holes. Gently pull legs through the leg
holes making sure that the strap is in *Using Child Growth
Standard (CGS).
front of the child.
*Basic information & body Orientation in
*Remember to record the child’s measurements needed: PHILIPPINE INTEGRATED
weight to the nearest decimal fraction (Age, Sex, Weight, MANAGEMENT OF
ACUTE MALNUTRITION
(e.g., 0.1 kg). Height/Length). (PIMAM)
MALNUTRITION
Measuring HEIGHT ANTHROPOMETRY
(WFL/H-Z Score)
*If the child is an INFANT or UNDER
2 years old, their height should be
measured while they are LYING
DOWN.
*This is a measurement of distance from

the top of the head to the soles (heels)
*If the child is 2 years old or OLDER

and can stand and maintain the correct
erect posture against a wall, their height
WFL/H (Z-Score)
should be determined by measuring
their height while they are STANDING NOTE:
UP.
For children above 2 y/o
*Read and Record the height to the who are UNABLE to
nearest 0.1 cm. STAND, the LENGTH is
measured and 0.7cm is
*It is recommended that this deducted from the Orientation in
measurement be taken with the help of measurement. PHILIPPINE INTEGRATED

MANAGEMENT OF
TWO CAREGIVERS. ACUTE MALNUTRITION
(PIMAM)
MALNUTRITION
ANTHROPOMETRY
CGS WEIGHT-FOR-LENGTH (WFL/H-Z Score) CGS WEIGHT-FOR-HEIGHT
CHILD GROWTH
STANDARDS TABLE
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
MALNUTRITION
WELL NOURISHED CHILD MAM SAM
EDEMA CHECK
N
U 0 0 +1, +2, +3
T
R
ANTHROPOMETRY I
(MUAC)
and and/or and/or
T
I
O
≥12.5cm 11.5cm to 12.4cm <11.5cm
N
A
L
ANTHROPOMETRY
S and and and/or
(WFL/H-Z Score)
T
A
T -2 to +2 SD <-2 to -3 SD <-3 SD
U Orientation in
S MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
MALNUTRITION
EDEMA CHECK
N
U
T
R
ANTHROPOMETRY I
(MUAC)
O
N
A Appetite Test &
L SAM Medical
Assessment
ANTHROPOMETRY
(WFL/H-Z Score) S
T
A
T
U Orientation in
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
NUTRITIONAL STATUS
WELL
NOURISHED MAM SAM
CHILD
Counseling/ Supplementary Appetite Test &

Community Feeding Medical
Mobilization Program (SFP) Assessment
Good Appetite or Poor Appetite or

+1, +2 Edema or +3 Edema or
Outpatient Inpatient
Therapeutic Therapeutic
Care (OTC) Care (ITC)
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
Outpatient Therapeutic Care (OTC)
ADMISSION
TREATMENT
WEEKLY MONITORING
Orientation in
DISCHARGE MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
New Admission
A *Anthropometry & Edema Checking

*Triage of Emergency Cases
D *Appetite Test, Medical History
M *Referral to ITC when needed
*Recording on OTC Registry Book
I
S Referred SAM
S *REVIEW & RECORD info of patient to OTC CHART & Registry

I Book.
*Continue with the same registration number on referral
O document.
N *Reassessment & Identification of additional health issues
*Complete existing registration and OTC Chart
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
A
D
M
REFERRAL FORM
I
S OTC CHART
S
I
REGISTRY
O BOOK
N Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
INFANT/ AGE in APPETITE BILATERAL MUAC WFH

CHILD MONTHS PITTING (cm) Z-
Admit to
A EDEMA Score OTC?
D ANNA 50 YES NO 10.2 <-3 SD
M BUBOY 45 YES YES 11.1 <-3 SD

I (+1)
S CARMELA 7 YES NO 11.7 >-3 SD

but
S <-2 SD
DANIEL 12 YES NO 9.5 >-3 SD
I but
<-2 SD
O EDEL 18 NO NO 10.4 <-3 SD
N Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
ADMISSION
TREATMENT
WEEKLY MONITORING
Orientation in
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
*Routine & Additional Medicines
*READY-to-USE THERAPEAUTIC FOOD
T *Orientation to caregiver (EBF for SAM 0-5 mos)
R Reminders
E *DO NOT give RUTF to UNDER 6 Months & with Allergy to Peanuts.
*Give NO OTHER FOODS until full daily ration of RUTF is consumed.
A *Iron and folic acid should NOT be given routinely. When moderate
T anemia is identified, treatment should begin only after 14 days in
the program and not before, because a high dose may increase the
M risk of severe infections.
*Zinc should not be given to patients taking RUTF.
E *Anti-emetics should not be used in OTC.
*Do NOT give cough suppressants.
N *Paracetamol should NOT be given routinely, due to its toxicity in a
malnourished child.
T *Aminophylline should not be used in OTC.
Orientation in
MANAGEMENT OF
*Ivermectin must be avoided in any edematous child. ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
T
R
E
A
T
M
E
N MAM
Ready-to-Use Therapeutic
Food (1 Sachet per day)
T Ready-to-Use Therapeutic
Orientation in
SAM MANAGEMENT OF
Food (2 Sachets per day) ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
ADMISSION
TREATMENT
WEEKLY MONITORING
Orientation in
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
*Anthropometric measurements and edema check

M *History, medical examination and appetite test
O *Referral to ITC when required
*Arrangement of home visit or further clinical/ social
N investigation when required
*Recording on OTC CHART & Ration Card
I *Resupply RUTF and complete medical treatment
T
O
R
I
N Orientation in
G
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
M The RHM/BNS/BHW at each weekly visit should:
O *Measure MUAC, Check Edema, Measure Weight (Weekly) &

Height (Monthly ONLY unless no record of height upon
N admission).
*Check MUAC & WHZ for discharge criteria.
I *Take body temperature
T *Appetite test for poor weight gain.
*Examine Child & Ask about the progress of the child
O including IMCI (Integrated Management of Childhood Illness)
R Danger Signs.
*Ask the mother about breastfeeding practices & any
I improvement in Milk Production for SAM Infants 0-5 mos.
*Give routine treatment at the appropriate visits.
N *Complete OTC Chart. Orientation in
G
*Make any necessary referrals for SAM with poor gain weight MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
ADMISSION
TREATMENT
WEEKLY MONITORING
Orientation in
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
*Orientation for caregiver
*RUTF
D *Refer for vaccination if required
I *Link to SFP and/or other services available
*IYCF counseling
S *Recording on OTC card & Registry Book
C
H When infant
A reaches 6 mos of
age, MUAC should
be taken to assess
R whether the infant
qualifies for
G enrolment in OTC
and to receive
E RUTF Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
Explain to the mother that the child has recovered sufficiently for
STEP 1
discharging. Congratulate them.
D The 9 mos old treated for OTC who doesn’t received MEASLES, mother should
STEP 2
I follow up at the RHU/BHS to ensure their child receives the vaccination.
Children admitted to OTC should get a follow-up appointment for 2nd measles
S STEP 3
vaccination (booster) after one month
C STEP 4
Child will get the last ration of RUTF (7 sachets good for one week), to aid
transition onto SFP (Supplementary Feeding Program).
H Mother should receive Counseling on IYCF Practices. If enrolled in 4P’s
STEP 5
A Program, ensure attendance in the Family Development Sessions (FDS).
All SAM patient should be discharged to the SFP for continued nutritional
R STEP 6
rehabilitation (if available).
G STEP 7
Mothers should be linked with IYCF Support Group & other
healthcare services which support the rehabilitation of the child.
E Fill in the patient record in the register with the discharge
Orientation in
STEP 8 details
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
INFANT/ AGE in WELL-BEING/ BILATERAL MUAC WFH Discharge

CHILD MONTHS APPETITE PITTING (cm) Z-Score
D EDEMA from OTC?
I ALLAN 6 Breastfeedin
g Effectivity
NO - >-2 SD
but
S BEA 24 Clinically NO 13.5

<-1 SD
-2 SD
C Well
H CHRIS 18 Fair Appetite YES

(+1)
12.5 >-2 SD
A
DELTA 4 Breastfeedin NO - -2 SD
R g Effectively
G EDWIN 36 Poor NO 11.5 <-3 SD

Appetite,
E Increase Rate
Orientation in
of Breathing MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
ADMISSION
TREATMENT
WEEKLY MONITORING
Orientation in
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
NUTRITIONAL STATUS
WELL
NOURISHED MAM SAM
CHILD


Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
Inpatient Therapeutic Care (ITC)
ADMISSION
PHASE 1 TREATMENT
TRANSITION
DISCHARGE to OTC
PHASE 2 in ITC
Orientation in
DISCHARGE from ITC PHILIPPINE INTEGRATED
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
A
D
M • Anthropometric measurements and edema check
I • Triage of emergency cases
S • History, medical examination, and appetite test
S • Referral to OTC where required
I • Recording
O
N
PHASE 1
T • Emergency medical management
R • Routine medicines & additional medicines
E • F75
A • Orientation to caregiver
T • Monitoring of feeds
M • Every 12 hrs and daily medical and anthropometric
Orientation in
E monitoring PHILIPPINE INTEGRATED
N • Recording and assessment of readiness for transition MANAGEMENT OF
ACUTE MALNUTRITION
T (PIMAM)
COMPONENTS OF PIMAM
ADMISSION
PHASE 1 TREATMENT
TRANSITION
DISCHARGE to OTC
PHASE 2 in ITC
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
T
R • Transition to RUTF
A • Continue medical treatments
N • Monitoring of feeds
S
I
• Every 12 hrs and daily medical and anthropometric
T monitoring
I • Recording
O • Assessment of readiness for OTC/Phase 2
N
D
I
S
C
• Orientation to caregiver
H
• RUTF till next OTC distribution
A
• Referral documentation and communication w/ OTC
R
Orientation in
G PHILIPPINE INTEGRATED
E MANAGEMENT OF
ACUTE MALNUTRITION
to OTC (PIMAM)
COMPONENTS OF PIMAM
ADMISSION
PHASE 1 TREATMENT
TRANSITION
DISCHARGE to OTC
PHASE 2 in ITC
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
• Rehabilitation with RUTF (or F100)

PHASE 2 • Daily monitoring
in • Health and nutrition education
ITC • Recording
• Assessment of readiness for discharge
D
I
S
C
• Orientation to caregiver
H
• Recording
A
• Links to other services (IYCF, SFP)
R
G Orientation in
E MANAGEMENT OF
ACUTE MALNUTRITION
from ITC (PIMAM)
COMPONENTS OF PIMAM
ADMISSION
PHASE 1 TREATMENT
TRANSITION
DISCHARGE to OTC
PHASE 2 in ITC
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
NUTRITIONAL STATUS
WELL
NOURISHED MAM SAM
CHILD


Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
Supplementary Feeding Program (SFP)
Nutrition Intervention Routine Child Health Services
Ready-to-Use Supplementary Breastfeeding Growth

Food (RUSF) & IYCF Monitoring
Local Recipes/ Locally Treatment of Acute Oral
Available Food & Chronic Illness Health
Fortified Blended Food or Hand
Counseling
Cereals Hygiene
Immunization Deworming
Micronutrient
Supplementation Orientation in
Care Practices & PHILIPPINE INTEGRATED
MANAGEMENT OF
Psychological Services ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
PRE-REQUISITE before DISCHARGE

At any follow up period, if the child reaches a WFL/H Z score of 2 or
above or a MUAC of 12.5 cm and above, WITHOUT Bilateral pitting
edema:
1) The child must maintain these criteria for 2 consecutive visits

(1 visit = 2 weeks).
2) During this time, the child must be continuously provided with 14

sachets of RUSF for another week.
3) While the maximum duration for treatment is 3 months for RUSF and 3
to 6 months for the locally food with 1 sachet MNP per day, the child
may not finish this long if he/she already reaches the discharge criteria Orientation in
for 2 consecutive visits MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
PROCEDURE for DISCHARGE

1) Inform caregiver the reason for DISCHARGE (child was able to reach the
desired Z-Score/ MUAC/ No Bilateral Pitting Edema for 2 consecutive
visits; 1 visit = 2 weeks).
2) Record Anthropometric measurements.
3) During the last visit, give last dose (take home) of RUSF (14 sachets; 1
sachet per day).
4) Check Immunization & IYCF.
5) Link to other services.

Orientation in
6) Follow up for 3 months. MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
COMPONENTS OF PIMAM
NUTRITIONAL STATUS
WELL
NOURISHED MAM SAM
CHILD


Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
MALNUTRITION
EDEMA CHECK
N
U
T
R
ANTHROPOMETRY I
(MUAC)
O
N
A Appetite Test &
L SAM Medical
Assessment
ANTHROPOMETRY
(WFL/H-Z Score) S
T
A
T
U Orientation in
ACUTE MALNUTRITION
(PIMAM)
Is it POSSIBLE to solve ACUTE MALNUTRITION?
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
This is how our Filipino babies look like…
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
This is how our Filipino babies SHOULD look like…
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
Are you ready to learn and Do your ROLE?
OUR GOAL
IS ZERO
SAM &
MAM
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)
THANK YOU 
Orientation in
MANAGEMENT OF
ACUTE MALNUTRITION
(PIMAM)

Orientation in PIMAM

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Orientation in PIMAM

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ACUTE MALNUTRITION (EASTERN SAMAR)

PHILIPPINE INTEGRATED MANAGEMENT OF Orientation in

At the end of the session, participants are

Lack of food, health and care are risk factors

MALNUTRITION is strongly linked with

15.00% 14.40% 14.71%

7.00% 6.51% 6.78%

2021 2022 2023

WFH/L-Z Score: -3SD to <-2SD (CGS) WFH/L-Z Score: <-3SD (CGS)

The sum of the prevalence of SAM &

Moderate Wasting (THIN)

Children with MAM are 3-4 times

WFH/L-Z Score: -3SD to <-2SD (CGS) WFH/L-Z Score: <-3SD (CGS)

The sum of the prevalence of SAM &

Children with SAM are 9-12

WFH/L-Z Score: -3SD to <-2SD (CGS) WFH/L-Z Score: <-3SD (CGS)

The sum of the prevalence of SAM &

You must test for Edema with

*This is a measurement of distance from

*If the child is 2 years old or OLDER

measurement be taken with the help of measurement. PHILIPPINE INTEGRATED

Counseling/ Supplementary Appetite Test &

Good Appetite or Poor Appetite or

A *Anthropometry & Edema Checking

S *REVIEW & RECORD info of patient to OTC CHART & Registry

INFANT/ AGE in APPETITE BILATERAL MUAC WFH

M BUBOY 45 YES YES 11.1 <-3 SD

S CARMELA 7 YES NO 11.7 >-3 SD

*Anthropometric measurements and edema check

M The RHM/BNS/BHW at each weekly visit should:

O *Measure MUAC, Check Edema, Measure Weight (Weekly) &

INFANT/ AGE in WELL-BEING/ BILATERAL MUAC WFH Discharge

S BEA 24 Clinically NO 13.5

H CHRIS 18 Fair Appetite YES

G EDWIN 36 Poor NO 11.5 <-3 SD

Counseling/ Supplementary Appetite Test &

Good Appetite or Poor Appetite or

• Rehabilitation with RUTF (or F100)

Counseling/ Supplementary Appetite Test &

Good Appetite or Poor Appetite or

Nutrition Intervention Routine Child Health Services

Ready-to-Use Supplementary Breastfeeding Growth

PRE-REQUISITE before DISCHARGE

1) The child must maintain these criteria for 2 consecutive visits

2) During this time, the child must be continuously provided with 14

PROCEDURE for DISCHARGE

2) Record Anthropometric measurements.

4) Check Immunization & IYCF.

5) Link to other services.

Counseling/ Supplementary Appetite Test &

Good Appetite or Poor Appetite or

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