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Recognition and Management of Malnutrition

6. IMCI Strategy for Nutritional Status Assessment

6.2. Moderate Acute Malnutrition

The IMCI criteria for moderate acute malnutrition in children 6-59 months of age include W/H z score between -3 and -2 or an MUAC between 115 to 125 mm. less than 115 or edema of both feet. Doctors Without Borders uses this same criteria for children up to 10 years of age but in adolescents from 10 to 18 years uses a W/H percentile between 70 and 80% because MUAC is not accurate. For older adults Doctors Without Borders uses an MUAC between 185 and 210 mm to indicate moderate acute malnutrition.

Table 10. IMCI Guidelines for Malnutrition for Children 6 to 59 Months

Assess Signs Classify as Treatment
  • W/H z score < -3 or
  • MUAC < 115 mm and
  • Able to finish RUTF<1

(YELLOW)

Uncomplicated Severe Acute Malnutrition

(YELLOW)

  • Give oral antibiotics for 5 days
  • Give RUTF for a child aged 6 months or more
  • Assess the child’s feeding and counsel the mother
  • Assess for possible TB infection
  • Schedule a follow-up visit after 7 days
  • Tell the mother when to come back immediately
  • W/H z score between -3 and -2 or
  • MUAC 115 up to 125 mm

(YELLOW)

Moderate Acute Malnutrition
Grade I

(YELLOW)

  • Assess the child’s feeding and counsel the caretaker/mother on feeding recommendations
  • Assess for possible TB infection
  • Schedule a follow-up visit after 7 days
  • Tell the caretaker/mother when to come back immediately
  • Follow up in 30 days

See: PAHO. IMCI program. Integrated Management of Childhood Common Illnesses Textbook, 2004.

Table 11. IMCI Guidelines for Malnutrition for Children 6 to 59 Months

Assess Signs Classify as Treatment
  • W/H z score -2 or more or
  • MUAC 125 or more
  • No signs of anemia, such as palmar pallor

(GREEN)

No Acute Malnutrition

(GREEN)

  • If child is less than 2 years old, assess the child’s feeding and counsel the caregiver/mother according to feeding recommendations
  • If there is any feeding problem, schedule control visit in 7 days

*See: PAHO. IMCI program. Integrated Management of Childhood Common Illnesses Textbook, 2004.

TABLE 12. Ambulatory therapeutic feeding program admission and discharge criteria

Children: 6 months to 10 years - Severe Acute Malnutrition without Medical Complications
Admission criteria
  • Presence of bilateral pitting edema or
  • MUAC <115 mm - only for children from 6 to 59 months or
  • W/H z score <-3Z
Discharge criteria
  • Absence of edema for at least one week
  • And
  • MUAC >115 mm on 2 consecutive visits
Children: 6 months to 10 years - Moderate Acute Malnutrition without Medical Complications
Admission criteria
  • WHZ between -3 and -2 or
  • MUAC between 115-125 mm with medical complications
Discharge criteria
  • WHZ >-2Z on 2 consecutive visits
Adolescents: 10 to 18 years (or 140-165 cm)
Admission criteria
  • Presence of bilateral pitting edema or
  • WH% <70%
Discharge criteria
  • Absence of edema for at least one week
  • And
  • WH% >80% on 2 consecutive visits
Moderately Malnourished Adolescents with Medical Complications
Admission criteria
  • WH% between 70% and 80% with medical complications
Discharge criteria
  • WH% >80% on 2 consecutive visits
Adults & Elderly >18 years old
Admission criteria
  • Presence of bilateral pitting edema Grade 3 or worse or MUAC <185 mm
Discharge criteria
  • Oedema less than Grade 2
  • And MUAC >210 mm on 2 consecutive visits
Adults & Elderly - Poor Clinical Conditions
Admission criteria
  • MUAC between 185 and 210 mm and poor clinical conditions
Discharge criteria
  • MUAC >185 mm and improved medical condition if transfer to SFP
  1. All patients with any type of oedema should receive a medical consultation to investigate if it is due to other causes.
  2. If the child is growing during her/his length of stay in the programme, discharge the child as cured using the admission target weight.
  3. Children suffering medical complications could be treated either in ITFC or in paediatric or medical ward with nutritional management
  4. For adolescents MUAC is not used as no cut-off has been defined.

Children with moderate acute malnutrition do not have bilateral pedal edema and they are able to finish their RUTF during an appetite test. If there are no IMCI medical complications identified that require hospitalization, these children can be managed at home preferably with an ATFC program. However children and adolescents having moderate malnutrition and a medical complication often need hospital admission based on their IMCI classification. When available these children need admission to either an ITFC or ATFC.