Consensus statement of the Indian academy of pediatrics on integrated management of severe acute malnutrition

Abstract

An integrated management of malnutrition is likely to yield more dividends. Thus, management of SAM should constitute an important component of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program. Determination of SAM on the basis of Z-scores using WHO Growth charts is considered statistically more appropriate than cut-offs based on percentage weight deficit of the median. Considering the fact that many children with SAM can be successfully managed on outpatient basis and even in the community, it is no more considered necessary to advise admission of all children with SAM to a healthcare facility. Management of SAM should not be a stand-alone program. It should integrate with community management therapeutic programs and linkages with child treatment center, district hospitals and tertiary level centers offering inpatient management for SAM and include judicious use of ready-to-use-therapeutic Food (RUTF). All sections of healthcare providers need to be trained in the integrated management of SAM.

How effective is the integration of facility and community-based management of severe acute malnutrition in India?

“…While such fi ndings may fi nd their roots in data recording at the facility level, a similar concern has also been raised by others. [14][15][16][17] The results of the study indicate that the programme was on the whole effective in ensuring relatively high levels of adherence to the follow-up visits. The study found a 24% dropout rate by the third follow-up visit, which increased to 35% for the fourth follow-up visit.…”

Outcome Study of NRC in Andhra Pradesh

“…The objective was to manage severe acute malnutrition as per WHO protocol. Protocol based management (2) decreases case fatality rate of severe acute malnutrition and ensures that the child does not suffer long-term consequences on the developing brain and physical stunting. (3) A 100 admissions spanning over 5 months in the year 2014 were analysed and the results were far from the quantitative indicators set by the program.…”

Management of SAM and MAM

“…Further, our country does not have sufficient hospital beds for offering inpatient care to all children with SAM. Indian Academy of Paediatrics (IAP) has, therefore, recommended an integrated management of malnutrition and has advised that, management of SAM should constitute an important component of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) Program (Dalwai, Choudhury et al, 2013). It has been recommended that, management of SAM should not be a standalone program but should integrate with community management of therapeutic programs, and have linkages with child treatment centre, district hospitals and tertiary level centres, offering inpatient management for SAM.…”