Recognition and Management of Malnutrition

Assessing the nutritional status of children and the presence of anemia is a integral part of the IMCI ask, look and listen strategy. The risk of death from acute respiratory infection, diarrhea, malaria, and other severe viral and bacterial is substantially increased when a child also has moderate or severe acute malnutrition and or severe anemia. Therefore children with medical conditions such as severe pneumonia, who according to IMCI could be managed in an ambulatory setting, need inpatient care if they also have moderate or severe acute malnutrition. The severity of malnutrition is assessed by looking for the presence bilateral edema of the feet and determining a child’s MUAC and or W/H z score. Using this information together with the medical assessment for cough, diarrhea, fever, and HIV infection (module 5), a child can be classified as complicated severe acute malnutrition (Pink-hospitalize), uncomplicated severe acute malnutrition (Yellow), moderate acute malnutrition (Yellow) or no acute malnutrition (Green).

Infants and children with complicated severe acute malnutrition should be urgently referred to the hospital, kept warm, given the first dose of an appropriate antibiotic and a feed to prevent low blood sugar. According to IMCI protocol uncomplicated severe acute malnutrition and moderate acute malnutrition can be managed at home with oral antibiotics as needed, ready to use therapeutic food, a feeding assessment and feeding counseling. This IMCI approach assumes that a hospital is the only available resource. However in certain situations the IMCI guidelines can be modified when there are inpatient therapeutic feeding centers (ITFC) and or ambulatory therapeutic feeding centers (ATFC). In addition IMCI malnutrition guidelines only target children 2 months to 5 years of age. Therefore, modifications based on the Doctors Without Borders guidelines for use with ITFC and ATFC for children from birth to age 18 will also be reviewed in this section.