In-patient therapeutic programme (ITP) is an important component of the overall integrated approach of managing acute malnutrition in the country. These guidelines provide practical and easy-to-follow guidance based on current evidence and best practices in the integrated management of SAM. The guidelines focus on management of SAM in children 6-59 months with medical complications in inpatient care. Infants under 6 months with SAM follow a specific treatment protocol. A separate section addresses the management of SAM in inpatient care in older age groups (i.e., older children ages 5-9 years, adolescents‟ ages 10-18 years, and adults over 18 years) and elderly in context of HIV/AIDS, Tuberculosis, Kala azar or malignancies. The guidelines will be used alongside those for Community Management of Acute Malnutrition (CMAM).
Malnutrition comprises both under and over nutrition. Undernutrition is a composite form of a deficiency in nutrient intake and/or absorption in the body. There are four forms of undernutrition: acute malnutrition, stunting, underweight and micronutrient deficiencies. The four forms can appear isolated or in combination but most often they overlap in one child or in a population. Undernutrition is identified through anthropometric indicators5 and clinical signs.
There are four common anthropometric nutrition indicators: mid-upper arm circumference (MUAC) and weight-for-height (WFH), which are used to assess wasting; height-for-age (HFA), which is used to assess stunting; and weight-for-age (WFA), which is used to assess underweight. There are two forms of acute malnutrition:
SAM, or severe acute malnutrition, is defined by the presence of bilateral pitting oedema or severe wasting, and other clinical signs such as poor appetite. A child with SAM is highly vulnerable and has a high risk of death.
MAM, or moderate acute malnutrition, is defined by moderate wasting.
The following terms are used to describe the clinical manifestations of SAM
Non Oedematous malnutrition, characterized by severe wasting of fat and muscle, which the body breaks down for energy, leaving „skin and bones‟
Oedematous malnutrition, characterized essentially by bilateral pitting oedema (usually starting in the feet and legs) and may spread all over the body if not treated, accompanied by a skin rash and/or changes in hair colour (greyish or reddish)