Managing severe acute malnutrition in children

Managing severe acute malnutrition in children

Managing severe acute malnutrition in children

Between one and two million children die each year around the world from wasting, or severe acute malnutrition (SAM) due to poverty and poor diet. Nevertheless SAM has been ignored by health programmes and the World Health Organization (WHO) does not recognise the term ‘acute malnutrition’.

ValidInternational (UK) has been studying ways of improving care for these severelymalnourished children. SAM is diagnosed in young children whose weight is morethan 70 percent below the average for their height or who have an upper-armcircumference of less than 11cm. Hospital mortality rates for children with SAMhave remained unchanged since the 1950s at 20-30 percent even though there havelong been ways of reducing mortality to below five percent. Even moreworryingly, hospital treatment reaches less than 10 percent of children whoneed it.

If trainedstaff looked after children in well-provisioned hospitals using the latestprotocol survival rates would increase dramatically. However, these childrenlive in the poorest regions of the poorest countries in the world. There arenot enough hospital beds or trained medical staff to care for them. Other waysof saving these children’s lives must be found.

Community-basedtherapeutic care is much cheaper and can reach many more children thantraditional hospital-based care. Health programmes which provide children withready-to-use food have proved successful. The special nutrient-dense food, withadded minerals and vitamins, does not need cooking and can be keptunrefrigerated for several months. Moreover, the food can be made from localcrops using basic local technology. The studies found that when children sufferingfrom SAM were treated in the community:

  • parents did not have totravel long distances, find money for fares, or leave work to accompanythe child
  • the proportion ofchildren suffering from SAM who were treated increased to 70 percent
  • children were treatedearlier and the number of deaths fell to four percent
  • beds and staff were made availablefor the sickest children with complications, such as diarrhoea,septicaemia and respiratory infections
  • the costs of treatingindividual children were significantly reduced. In Bangladesh for example,home-based care cost as little as a fifth of hospital care: US$29 insteadof US$156.

Economicdevelopment and public health programmes to improve diet in these regions wouldprevent almost all of these deaths. The study recommends that:

  • community-based care forSAM should be scaled up with training for medical and nursing staff
  • WHO adopts the term‘acute malnutrition’ so that ‘wasting’, where the child is much too thin,can be differentiated from ‘stunting’ or stunted growth. The twoconditions, both caused by malnutrition, require different treatment
  • wasting must be given ahigher profile, and given in official records as the cause of death, sothat decision-makers are made aware of it
  • health campaigns need toinform policymakers and funders that there are successful, inexpensiveways of treating wasting
  • measuring the circumference of achild’s arms should be included as a standard element in growth monitoringprogrammes so that the condition is caught early, before complicationsarise, and can be treated in the community.