South Sudan: Guidelines for Inpatient Management of Severe Acute Malnutrition

Source: UN Children's Fund, Government of the Republic of South Sudan
Country: South Sudan

1.0 Background

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).

1.1 Introduction

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)