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evere acute malnutrition remains a major killer of children under five years of age. Until recently treatment has been restricted to facility based approaches greatly. limiting its coverage and impact New evidence suggests however that large. numbers of children with severe acute malnutrition can be treated in their communities. without being admitted to a health facility or a therapeutic feeding centre. The community based approach involves timely detection of severe acute malnutrition. in the community and provision of treatment for those without medical complications. with ready to use therapeutic foods or other nutrient dense foods at home If properly. combined with a facility based approach for those malnourished children with medical. complications and implemented on a large scale community based management of. severe acute malnutrition could prevent the deaths of hundreds of thousands of children. Nearly 20 million children under five The large burden of child mortality due to severe. acute malnutrition remains largely absent,suffer from severe acute malnutrition. from the international health agenda and few, Severe acute malnutrition is defined by a very low countries even in high prevalence areas have. weight for height below 3 z scores1 of the median specific national policies aimed at addressing it. WHO growth standards by visible severe wasting comprehensively With the addition of community. or by the presence of nutritional oedema In based management to the existing facility based. children aged 6 59 months an arm circumference approach much more can now be done to address. less than 110 mm is also indicative of severe acute this important cause of child mortality. malnutrition Globally it is estimated that there are. nearly 20 million children who are severely acutely Severe acute malnutrition in children. malnourished 2 Most of them live in south Asia and. can be identified in the community,in sub Saharan Africa. before the onset of complications,Community health workers or volunteers can. Severe acute malnutrition contributes easily identify the children affected by severe. to 1 million child deaths every year acute malnutrition using simple coloured plastic. Using existing studies of case fatality rates in, several countries WHO has extrapolated mortality Mortality of children with severe acute.
rates of children suffering from severe acute malnutrition observed in longitudinal studies. malnutrition The mortality rates listed in the table Country Mortality rate. at right reflect a 5 20 times higher risk of death Congo Democratic Republic of the 21. compared to well nourished children Severe acute Bangladesh 20. malnutrition can be a direct cause of child death Senegal 20. or it can act as an indirect cause by dramatically. increasing the case fatality rate in children suffering. from such common childhood illnesses as diarrhoea, and pneumonia Current estimates suggest that Note For studies of less than 12 months rate was adjusted for duration of follow up. about 1 million children die every year from severe. Sources Congo Democratic Republic of the Van Den Broeck J R Eeckels and J. acute malnutrition 3 Vuylsteke Influence of nutritional status on child mortality in rural Zaire The Lancet. vol 341 no 8859 12 June 1993 pp 1491 1495 Bangladesh Briend A B Wojtyniak. and M G Rowland Arm circumference and other factors in children at high risk of. death in rural Bangladesh The Lancet vol 2 no 8561 1987 pp 725 728 Senegal. Garenne Michel et al Risques de d c s associ s diff rents tats nutritionnels. chez l enfant d ge pr scolaire Etude r alis e Niakhar S n gal 1983 1983. A z score is the number of standard deviations below or above the reference mean Paris CEPED 2000 Uganda Vella V et al Determinants of child nutrition and. or median value mortality in north west Uganda Bulletin of the World Health Organization vol 70. no 5 17 September 1992 pp 637 643 Yemen Bagenholm G C and A A Nasher. WHO is currently estimating the global number of children suffering from severe. Mortality among children in rural areas of the People s Democratic Republic of. acute malnutrition and the number of deaths associated with the condition Yemen Annals of Tropical Paediatrics vol 9 no 2 June 1989 pp 75 81. strips that are designed to measure mid upper of the next supply of RUTF should be done weekly. arm circumference MUAC In children aged 6 59 or every two weeks by a skilled health worker in a. months a MUAC less than 110 mm indicates severe nearby clinic or in the community. acute malnutrition which requires urgent treatment. Community health workers can also be trained to, recognize nutritional oedema of the feet another Community based management of. sign of this condition severe acute malnutrition can have a. Once children are identified as suffering from severe. major public health impact, acute malnutrition they need to be seen by a health. With modern treatment regimens and improved,worker who has the skills to fully assess them. access to treatment case fatality rates can be,following the Integrated Management of Childhood.
as low as 5 per cent both in the community,Illness IMCI approach The health worker should. and in health care facilities Community based,then determine whether they can be treated in the. management of severe acute malnutrition was, community with regular visits to the health centre. introduced in emergency situations It resulted in a. or whether referral to in patient care is required. dramatic increase of the programme coverage and,Early detection coupled with decentralized. consequently of the number of children who were,treatment makes it possible to start management.
treated successfully yielding a low case fatality rate. of severe acute malnutrition before the onset of life. The same approach can be used in non emergency,threatening complications. situations with a high prevalence of severe acute,malnutrition preventing hundreds of thousands of. child deaths when applied at scale,Uncomplicated forms of severe acute. malnutrition should be treated in the,community Ready to use therapeutic foods. In many poor countries the majority of children Children with severe acute malnutrition need safe. who have severe acute malnutrition are never palatable foods with a high energy content and. brought to health facilities In these cases only adequate amounts of vitamins and minerals RUTF. an approach with a strong community component,can provide them with the appropriate care.
Evidence shows that about 80 per cent of children,with severe acute malnutrition who have been. identified through active case finding or through,sensitizing and mobilizing communities to access. decentralized services themselves can be treated,The treatment is to feed children a ready to use. therapeutic food RUTF until they have gained,adequate weight In some settings it may be. possible to construct an appropriate therapeutic diet. using locally available nutrient dense foods with,added micronutrient supplements However this.
approach requires very careful monitoring because,nutrient adequacy is hard to achieve. Marko Kerac 2004, In addition to the provision of RUTF children need. to receive a short course of basic oral medication to. treat infections Follow up including the provision. recovery are lower among these children than,among those who are HIV negative and their case. fatality rate is higher The lower weight gain is, probably related to a higher incidence of infections. in children who are HIV positive,Given the overlap in presentation of severe acute.
malnutrition and HIV infection and AIDS in children. especially in poor areas strong links between,Valid International. community based management of severe acute,malnutrition and AIDS programmes are essential. Voluntary counselling and testing should be, available for children with severe acute malnutrition. and for their mothers If diagnosed as HIV positive. are soft or crushable foods that can be consumed,they should qualify for cotrimoxazole prophylaxis. easily by children from the age of six months,to prevent the risk of contracting Pneumocystis.
without adding water RUTF have a similar nutrient,pneumonia and other infections and for. composition to F100 which is the therapeutic diet,antiretroviral therapy when indicated At the same. used in hospital settings But unlike F100 RUTF are. time children who are known to be HIV positive,not water based meaning that bacteria cannot grow. and who develop severe acute malnutrition should, in them Therefore these foods can be used safely at. have access to therapeutic feeding to improve their. home without refrigeration and even in areas where. nutritional status,hygiene conditions are not optimal.
When there are no medical complications a, malnourished child with appetite if aged six months Ending severe acute malnutrition. or more can be given a standard dose of RUTF, adjusted to their weight Guided by appetite children Prevention first. may consume the food at home with minimal, supervision directly from a container at any time of Investing in prevention is critical Preventive. the day or night Because RUTF do not contain water interventions can include improving access to. children should also be offered safe drinking water to high quality foods and to health care improving. drink at will nutrition and health knowledge and practices. effectively promoting exclusive breastfeeding for the. The technology to produce RUTF is simple and can first six months of a child s life where appropriate. be transferred to any country with minimal industrial promoting improved complementary feeding. infrastructure RUTF cost about US 3 per kilogram practices for all children aged 6 24 months with. when locally produced A child being treated for a focus on ensuring access to age appropriate. severe acute malnutrition will need 10 15 kg of complementary foods where possible using locally. RUTF given over a period of six to eight weeks available foods and improving water and sanitation. systems and hygiene practices to protect children,against communicable diseases. Community based management, of severe acute malnutrition in the but treatment is urgently needed for those.
who are malnourished,context of high HIV prevalence. Severe acute malnutrition occurs mainly in families. The majority of HIV positive children suffering, that have limited access to nutritious food and are. from severe acute malnutrition will benefit from,living in unhygienic conditions which increase. community based treatment with RUTF However,the risk of repeated infections Thus preventive. experience shows that rates of weight gain and,programmes have an immense job to do in the.
context of poverty and in the meantime children 2 Providing the resources needed for management. who already are suffering from severe acute of severe acute malnutrition including. malnutrition need treatment Making RUTF available to families of. children with severe acute malnutrition, In May 2002 the Fifty Fifth World Health Assembly through a network of community health. endorsed the Global Strategy for Infant and workers or community level health facilities. Young Child Feeding which recommends actively preferably by encouraging the local food. searching for malnourished infants and young industry to produce RUTF in settings where. children so they can be identified and treated The families do not have access to appropriate. development of the community based approach local foods. for the management of severe acute malnutrition Ensuring funding to provide free treatment. should provide a new impetus for putting this of severe acute malnutrition because affected. recommendation into practice It is urgent families are often among the poorest. therefore that this approach along with preventive 3 Integrating the management of severe acute. action be added to the list of cost effective malnutrition with other health activities such as. interventions to reduce child mortality Preventive nutrition initiatives including. promotion of breastfeeding and appropriate,complementary feeding and provision. of relevant information education and,What countries can do communication IEC materials. Activities related to the Integrated,Countries can save children s lives by. Management of Childhood Illness at first,level health facilities and at the referral.
1 Adopting and promoting national policies and,level and initiating such activities where. programmes that,they do not exist,Ensure that national protocols for the. management of severe acute malnutrition,WHO WFP SCN UNICEF and other partners. based if necessary on the provision of will support these actions by. RUTF have a strong community based, component that complements facility based Mobilizing resources to support implementation. activities of these recommendations, Achieve high coverage of interventions Facilitating the local production or procurement.
aimed at identifying and treating children of RUTF for countries with a high prevalence of. in all parts of the country and at all times severe acute malnutrition in communities where. of the year through effective community access to nutrient dense foods is limited. mobilization and active case finding Supporting the development and evaluation of. COMMUNITY BASED MANAGEMENT OF SEVERE ACUTE MALNUTRITION A Joint Statement by the World Health Organization the World Food Programme the United Nations System Standing Committee on Nutrition and the United Nations Children s Fund 440454Eng Cov indd 20454Eng Cov indd 2 44 12 07 6 31 35 PM 12 07 6 31 35 PM Process CyanProcess CyanPProcess Magentarocess MagentaPProcess Yellowrocess

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