10.1 Severe acute malnutrition: deciding patient management
When thinking about severe acute malnutrition you should have in mind all the vital organs in the body such as the heart, the kidneys and the liver. When a child or adult is severely malnourished, these organs do not function properly. Therefore severely malnourished children are at an increased risk of death if their malnutrition is not identified and treated in a timely way. You need to know the steps required to assess, classify and treat severely malnourished children.
Your first step is to decide whether to provide out-patient management or refer the child to an in-patient facility. Look at the flow chart in Table 10.1 which shows you how to classify the condition of a child and the recommended action you need to take. If you read the table from left to right, you can see how your assessment of the child’s symptoms will enable you to classify the level of malnutrition and whether you need to refer the child to an in-patient facility.
Table 10.1 Flow chart for assessment, classification and action required for malnourished children. (Source: Federal Ministry of Health, 2008, Management of severe acute malnutrition)
Which children with the classification of severe acute malnutrition can be treated at health post level?
As you can see from the flow-chart in Table 10.1, you can treat children with severe uncomplicated malnutrition at health post level, but children with severe complicated malnutrition need to be referred urgently to TFU.
The Federal Ministry of Health has produced guidance (July 2008) on the management of children with severe acute malnutrition at a health post. This provides additional information not covered in this study session.