This document provides an overview of integrated management of acute malnutrition. It defines malnutrition as deficiencies, excesses, or imbalances in energy and nutrient intake. Acute malnutrition is classified as moderate or severe based on wasting and edema. Causes include inadequate dietary intake and diseases. Identification methods include mid-upper arm circumference and weight-for-height measurements. Treatment involves stabilization, transition, and rehabilitation phases with specialized therapeutic foods depending on the severity of malnutrition. Close monitoring of vital signs and intake is also required.
According to the WHO, malnutrition is by far the biggest contributor to child mortality
Under-weight births and IUGR (intra-uterine growth restrictions) cause 3 million child deaths a year.
According to the Lancet, consequences of malnutrition in the first two years is irreversible.
Malnourished children grow up with worse health and lower educational achievements.
Malnutrition can exacerbate the problem of diseases such as measles, pneumonia and diarrhoea.
But malnutrition can actually cause diseases itself , and can be fatal in its own right
The term 'faltering growth' is widely used in relation to infants and young children whose weight gain occurs more slowly than expected for their age and sex.
In the past, this was often described as a ‘failure to thrive’ but this is no longer the preferred term :-
partly because ‘failure’ could be perceived as negative,
but also because lesser degrees of faltering growth may not necessarily indicate a significant problem but merely represent variation from the usual pattern when measured against the standardized growth charts (WHO Growth Charts
SPHERE, Oxfam, Red R, Save the Children, IMNCI presentations were summarized for Emergency Food Security and Livelihoods meet in Kolkata 10th February 2011
According to the WHO, malnutrition is by far the biggest contributor to child mortality
Under-weight births and IUGR (intra-uterine growth restrictions) cause 3 million child deaths a year.
According to the Lancet, consequences of malnutrition in the first two years is irreversible.
Malnourished children grow up with worse health and lower educational achievements.
Malnutrition can exacerbate the problem of diseases such as measles, pneumonia and diarrhoea.
But malnutrition can actually cause diseases itself , and can be fatal in its own right
The term 'faltering growth' is widely used in relation to infants and young children whose weight gain occurs more slowly than expected for their age and sex.
In the past, this was often described as a ‘failure to thrive’ but this is no longer the preferred term :-
partly because ‘failure’ could be perceived as negative,
but also because lesser degrees of faltering growth may not necessarily indicate a significant problem but merely represent variation from the usual pattern when measured against the standardized growth charts (WHO Growth Charts
SPHERE, Oxfam, Red R, Save the Children, IMNCI presentations were summarized for Emergency Food Security and Livelihoods meet in Kolkata 10th February 2011
Nutritional disorders range from overweigh, obesity, protein calorie malnutrition to starvations. it ie sthe is the end result of chronic nutritional and, frequently, emotional deprivation by caregivers who, because of poor understanding, poverty or family discord, are unable to provide the child with the nutrition and care he or she requires These disorders affect both the rich the poo and those in conflict zonesr
The poverty rate in India is impacting the economy and Malnutrition (Undernutrition) is a consequence of poverty. There are various ways to combat malnutrition including SAM management strategies along with various ongoing nutrition improvement programs focusing on maternal and child health.
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
Nutritional disorders range from overweigh, obesity, protein calorie malnutrition to starvations. it ie sthe is the end result of chronic nutritional and, frequently, emotional deprivation by caregivers who, because of poor understanding, poverty or family discord, are unable to provide the child with the nutrition and care he or she requires These disorders affect both the rich the poo and those in conflict zonesr
The poverty rate in India is impacting the economy and Malnutrition (Undernutrition) is a consequence of poverty. There are various ways to combat malnutrition including SAM management strategies along with various ongoing nutrition improvement programs focusing on maternal and child health.
Nutritional assessment using anthropometric, biochemical, clinical, and dietary methods with a larger understanding of anthropometric methods used in Ethiopia
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
2. COVERAGE OF THE PRESENTATION
INTRODUCTION
DEFINITION OF MALNUTRITION
CAUSES OF MALNUTRITION
IDENTIFICATION OF MALNUTRITION
INPATIENT THERAPEUTIC CARE OF
SEVERELY MALNOURISHED CHILDREN
3. INTRODUCTION
• What is malnutrition? Malnutrition refers to deficiencies,
excesses or imbalances in a person’s intake of energy and/or
nutrients. The term malnutrition is categorized as
undernutrition and overnutrition
4. Cont.………………
• Undernutrition— includes stunting (low height for age),
wasting (low weight for height), underweight (low weight for
age) and micronutrient deficiencies or insufficiencies (a lack of
important vitamins and minerals)
• Overnutrition which include overweight and obesity .
5. Cont.……………….
• Undernutrition is one of the contributing factors to high
morbidity and mortality among children under the age of five
years in Tanzania. Acute Malnutrition is classified into severe
acute malnutrition (SAM) and moderate acute malnutrition
(MAM) according to the degree of wasting and the presence or
absence of oedema.
6. CAUSES OF MALNUTRITION
• Immediate causes -The immediate causes of malnutrition in
Tanzania can be categorized into two: dietary causes and
diseases which reinforce each other. Dietary causes relate to
low or excessive frequency of feeding, dietary diversity and
adequacy of the food taken in relation to physiological and
physical needs
7. Cont.……………….
• Underlying causes- underlying causes of malnutrition occur
at the household level. include insufficient household food
security, inadequate child and maternal care and inadequate
basic services, particularly those related to health, water and
sanitation.
• Basic cause-They include poverty, inadequate nutrition and
general political governance, ignorance due to low education,
nutrition unfriendly customs and traditions.
8. IDENTIFICATION AND CLASSIFICATION
OF MALNUTRITION
• Active case finding is essential for identification of cases
before complications arise and is a critical component of all
programs to treat SAM and MAM. All opportunities to screen
children for acute malnutrition should be used, both in
communities and at health facilities. This screening should be
done routinely at community level by community-health
workers/volunteers (CHWs) and upon entry to all health
facilities.
9. Cont.………………….
Different methods may be used to identify acute malnutrition,
depending on the circumstance and equipment available.
Acceptable options are:
• Community: Mid-Upper Arm Circumference (MUAC) and
check for oedema
• Inpatient health facilities: Weight for height/length and
MUAC and check for presence of oedema
• Inpatient health facilities without capacity to measure
height/length: MUAC as in (I) and check for oedema
10. Mid-Upper Arm circumference (MUAC)
• MUAC is a simple technique that can be used as a measure of
wasting for children aged 6-59 months. Table below shows the
classification of malnutrition (based on the degree of wasting
and oedema) and the referral routes, which take into account
the severity of acute malnutrition, presence of complications
and the child’s appetite
11. Table 1: Classification of acute
malnutrition and referral routes
MUAC
Presence of
complications or poor
appetite
Oedema grade Classification of
malnutrition
Refer to:
>12.5cm (no wasting)
No Any grade severe
Inpatient therapeutic
care
11.5 to <12.5(moderate
wasting) No No moderate
Counseling on optimal
feeding
No
Any grade severe Inpatient therapeutic
care
Yes
No
Moderate with
complications
Inpatient treatment of
complications according
to IMCI
<11.5 (severe wasting)
No No
severe OPD for therapeutic care
No
Any grade severe Inpatient therapeutic
care
Yes
No/yes Severe with
complications
Inpatient therapeutic
care
12. Cont.……..
• N.B. Severe malnutrition is severe wasting (MUAC <11.5)
and/or oedema.Moderate malnutrition is moderate wasting
(MUAC 11.5 to <12.5 and no oedema.
• WEIGHT FOR HEIGHT/LENGTH
• Low weight for height/length denotes wasting. Weight for
length is used for children 6 month to below 2 years, or for
children too weak to stand.
13. Table: Classification of acute
malnutrition and referral routes
Weight for Height/
Length
Presence of
complications or poor
appetite
Oedema grade
Classification of
malnutrition
Refer to:
>-2 SD
No
Any grade severe Inpatient therapeutic
care
-3SD to<-2SD
(Moderate wasting)
No
No moderate Counseling for optimal
feeding
No
Any grade severe Inpatient therapeutic
care
Yes
No Moderate with
complications
Inpatient treatment of
complications according
to IMCI
<-3SD (Severe wasting) No
No severe OPD for therapeutic care
No
Any grade severe Inpatient therapeutic
care
Yes
No or yes Severe with
complications
Inpatient therapeutic
care
14. Cont.……………
• N.B. Severe malnutrition is severe wasting (weight for height
<-3SD weight) and/ or oedema. Moderate malnutrition is
moderate wasting (weight for height -3SD to <-2SD) and no
oedema.
15. CHECKING FOR OEDEMA
Nutritional oedema usually starts in the feet and then in the lower
legs and can spread to the hands, lower arms and face.
Mild + Feet only
Moderate ++ Feet, legs, hands and
forearms
Severe +++ Generalized oedema,
including feet, legs, hands
and face
16. INFANTS LESS THAN 6 MONTHS
• The diagnosis of infants less than 6 months is
based on:
• Weight for Length <-3SD
• Bilateral pitting oedema of feet
• The infant does not gain weight or lose more
than 10% of the initial weight
17. INPATIENT THERAPEUTIC CARE OF SEVERELY
MALNOURISHED CHILDREN 6-59 MONTHS
The management of SAM is divided into three phases:
• Stabilization phase ( day 1-3) covers nutrition (including
feeding with F75) and medical stabilization, treatment of life-
threatening medical complications and correction of
micronutrient deficiencies. Patients do not gain weight during
this phase. The patient remains in stabilization phase until the
medical complications have stabilized and the appetite
improves.
18. Cont.………………
• Feeding should be started as soon as possible after admission
and should be designed to provide just sufficient energy and
protein to maintain basic physiological processes.
• During stabilization, feed F75 (130ml/kg/day), either using
F75 sachets or recipes
• Note; Use recommended dose schedule based on admission
weight. If child has severe (+++) oedema, use F75
100ml/kg/day
19. Cont.…………………
• Give F75 2 hourly on admission (12 feeds per day). Always
give feeds on time (within 15 minutes of the prescribed time).
Give feeds orally or by nasogastric tube (NGT) · Feed the
child throughout (day and night) to prevent hypoglycaemia ·
• Keep the total daily dose the same throughout phase 1, even if
the child loses weight
20. Cont.……………….
• If the child is breastfed, continue breastfeeding, but make sure
the child takes the entire prescribed amount of F75.No food
other than F75 and/or breast milk should be given during
stabilization.
• Preparation of F75 · If ready to use F75 is available, follow
instructions as written on the sachet/tin. Alternative recipes for
F 75 are found if ready to use is not available.
21. Cont.……………
• Transition phase (3-7 days) covers a transition from F75 to
F100 or RUTF and a gradual increase in diet leading to some
weight gain while preventing complications of overfeeding.
Patients normally remain in this phase for two to three days.
• A gradual transition is necessary from Stabilization Phase
(using F75) to Rehabilitation Phase (using F100 or RUTF) to
prevent fluid overload and heart failure.
22. Cont.………………
• Criteria to move from Stabilization Phase to Transition
Phase Child must meet all of the following criteria
• Appetite has improved and child is taking all of the
prescribed milk.
• Treatment of medical complications has commenced and
patient is improving
• Loss of or minimal oedema
• IV fluids and NGT feeding completed.
• Child can take feeds orally.
23. Feeding during transition
• In transition phase, the patient begins to gain some weight
slowly. Feed as follows: ·
• Replace F75 feeds with the same amount of F100 for the first
2 days. On day 3, increase each successive feed by 10 ml as
long as the child finishes feeds. Continue increasing by 10ml
until food is left after most feeds.
24. Cont.………………….
• The amount of F100 should not exceed the maximum amount
recommended for the child’s weight · Breastfed children
should be offered breast milk on demand before being fed
F100. If the child has good response, medical complications
are resolved and has good appetite, RUTF can gradually be
introduced up to 200kcal/kg/day · Timing of F100 feeds in
Transition Phase (i.e. number of feeds per day) is the same as
in Stabilization Phase.
25. Criteria to progress between the
phases
• Criteria to progress from transition to rehabilitation phase
• A good appetite this means child is taking at least 90% of the
F100 or RUTF prescribed during transition phase.
• Reducing oedema
• Resolving medical complications or no medical complications
• Clinically well and alert
26. Rehabilitation phase
• Rehabilitation phase (2-6 weeks) This section describes the
rehabilitation phase for the small proportion of children who
will remain in ITC throughout the rehabilitation phase
otherwise; the majority of children should be treated on an
outpatient basis. This phase is associated with full recovery
and rapid catch up of lost weight. Either F100 or RUTF or a
combination of both can be used. The main change in the diet
is an increase in the amount of F100 or introduction to RUTF.
27. MONITORING
The following should be monitored and entered into the child’s
treatment card
• Weight is measured every day at the same time (before feeds)
• Degree of oedema is assessed every day
• Body temperature is measured twice per day.
• Pulse and respiratory rates 4 hourly (more frequently when
taking fluids e.g. rehydration and blood transfusion).
28. Cont.……………….
• Standard clinical signs: stool, vomiting, dehydration,
cough.
• Patient’s fluid intake and route (oral, NGT, or IV fluids).
• Record if the patient vomits or refuses a feed
• MUAC is taken upon admission and thereafter on each
7th day