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- 1. 12/24/2025 1 PREPARED BY :URJI GIRMA SEVERE ACUTE MALNUTRITION
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- 3. 12/24/2025 3 OUTLINE INTRODUCTION EPIDIMOLOGY ETIOLOGY TYPES AND CLASSIFICATION HOW TO DIAGNOSE ADDMISSION CRITERIA MANAGEMENT PRINCEPLE COMLICATIONS PREVENTION
- 4. 12/24/2025 4 INTRODUCTION Definition TheWorld Health Organization defines malnutrition as: "The cellular imbalance between supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions.“
- 5. 12/24/2025 5 Cont… Nutritional deficienciesconstitute major public health problems in the tropical and subtropical regions of the world. It affects mostly children under five years of age, As their nutritional requirements are relatively greater than those of older children. As cultural reason they are given small amount and less nutritious diet. As they are highly dependent on their care taker. As the incidence of infection is high in this age group.
- 6. 12/24/2025 6 EPIDIMOLGY Prevalence ofPEM in Ethiopia, EMDHS 2019 Under-five children: Stunted: 37% Underweight: 21% Wasted: 7% Women: 25% with low BMI
- 7. 12/24/2025 7 ETIOLOGY Protein-energy malnutritionresults from the interaction of several factors of which inadequate diets and infectious diseases are most important
- 8. 12/24/2025 8 Human, Economic, and InstitutionalResources Nutritional Status Health Diet Household Food Security Potential Resources Ecological Conditions Care of Mother and Child Environ. Health, Hygiene & Sanitation Political and Ideological Structure Root Causes Manifestations Immediate Causes Underlying Causes Functional Consequences: Mortality, Morbidity, Lost Productivity, etc. Consequences
- 9. 12/24/2025 9 Etiology of edemain SAM There are different theories 1. Dietary protein – calorie ratio 2. Adaptation theory and Hormonal theory 3. Free radical theory 4. Renal insufficiency 5. Electrolyte imbalance
- 10. 12/24/2025 10 TYPES Under nutrition: Protein Energy Malnutrition (PEM) - Marasmus - Kwashiorkor - Marasmic-Kwashiorkor Micronutrient deficiencies - Vitamin A deficiency - preventable blindness - Iron deficiency – anaemia - Iodine deficiency - brain damage - Vit B - … - Vit C - scurvy - Vitamin D deficiency - rickets - Over nutrition: Obesity
- 11. 12/24/2025 11 Other types Recentlypreferred classification based on clinical picture Edematous malnutrition Non-edematous malnutrition
- 12. 12/24/2025 12 Peripheral signs ofmalnutrition Clinical presentation Edematous Non edematous Peak age 12 – 36 months 6 – 12months Growth retardation Absent Present Mental changes Apathy Irritable Appetite Poor Good Kwash – dermatosis Present Absent Hair color and skin change Common Infrequent Moon face Present Absent Hepatomegaly Present Absent Long and curled eye lash Present Present Anemia Present Present Pot belly abdomen Present Present Diarrhea Present Present
- 13. 12/24/2025 13 OTHER CLASSIFICATION Severalmethods have been suggested for the classification of PEM. Based on the etiology of PEM Primary malnutrition malnutrition resulting from inadequate food intake or lack of food. e.g. poverty, drought
- 14. 12/24/2025 14 Conte… Secondary malnutritionrefers to malnutrition resulting from increased nutrient needs decreased nutrient absorption and/or increased nutrient losses. Mixed - Both primary and secondary malnutrition
- 15. 12/24/2025 15 HOW TO DIAGNOSESAM MUAC <11.5 cm Any degree of bilateral pitting oedema WFH <-3 z-score
- 16. 12/24/2025 16 additional the extentof dermatosis can be described in the following way: + (mild): discoloration or a few rough patches of skin + + (moderate): multiple patches on arms and/or legs + + + (severe): flaking skin, raw skin, fissures (openings in the skin)
- 17. 12/24/2025 17 Basic Dx forSAM Pts ANTROPOMERTIC MEASUREMENT RBC SERUM ELECTROLITE CBC U/A PIHCT
- 18. 12/24/2025 Dr Sentayehu S 18 WHOGrowth Curves WHO growth curves are: Age and gender specific Extend from birth to 5 years Weight for age: boys and girls Height/length for age: boys and girls Head circumference for age: boys and girls Weight for height/length: boys and girls BMI for age: boys and girls
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- 21. 12/24/2025 21 Admission criteria totherapeutic feeding programmes 6months -5 yrs
- 22. 12/24/2025 22 Infants 0-6 monthsof age should be managed and follow up Any grade of bilateral pitting oedema WFL < -3 z-score Any medical complications Recent weight loss or failure to gain weight Ineffective feeding Any medical or social issue needing more detailed assessment or intensive support
- 23. 12/24/2025 23 MANAGEMENT PRINCIPLES Dietarymanagement Manage macronutrient deficiency and Include Correction of associated micronutrient deficiencies Treatment of complications Including deworming for parasites Monitoring and follow -up Stimulation Prevention of relapse: Health education Immunization
- 24. 12/24/2025 24 Conte… Phase 1 Theformula used during this phase (F75) promotes recovery of normal metabolic function and nutrition- electrolytic balance. Rapid weight gain at this stage is dangerous.
- 25. 12/24/2025 25 Conte… Amount ofF75 given every 2 hr with small amount Breast feeding child should be encoraged
- 26. 12/24/2025 26 Conte… Transition Phase Duringthis period, introduce RUTF gradually alongside F-75. Some children may initially refuse the RUTF; continue to offer RUTF at every feed until they begin to eat the prescribed amounts.
- 27. 12/24/2025 27 Criteria to RehabilitationPhase(phase- 2) in SC A good appetite: Takes all the F-100 prescribed for the transition phase (150 kcal/kg/day). Oedema reduced to moderate (++) or mild (+). If wasting with bilateral pitting oedema, oedema should completely disappear. Medical complications are resolving. Clinically well and alert.
- 28. 12/24/2025 28 Feeding in infant< 6 months The objective is to supplement the child’s breastfeeding with therapeutic milk while stimulating breast milk production. The infant should be breastfed as frequently as possible. Breastfeed every 3 hours for at least 20 minutes (more if the child cries or demands more). Give F-100-Diluted to breastfed infants without bilateral pitting oedema..
- 29. 12/24/2025 29 Conte… Give F-75to infants with bilateral pitting oedema and change to F-100-Diluted when the oedema is resolved. Never give full strength F-100 to infants 0-6 months old. Use the reference tables for amounts of F-100-Diluted or F-75 to give to infant. Use the supplementary suckling technique.
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- 32. 12/24/2025 32 COMPLICATIONS Hypoglycemia Hypothermia Heart failure Severe anemia Dehydration Infection Poorappetite intractable vomiting, convulsions, lethargy, not alert, unconsciousness, fever persistent diarrhoea severe skin lesions
- 33. 12/24/2025 33 DISCHARGE CRITERIA weight-for-height/lengthis ≥–2 Z-score and they have had no oedema for at least 2 weeks. mid-upper-arm circumference is ≥125 mm and they have had no oedema for at least 2 weeks.
- 34. 12/24/2025 34 prevention of Malnutrition Breast feeding Complementary feeding Nutrition supplementation Vitamin A supplementation PMTCT Measles vaccination Family Planning Management of severe malnutrition Zinc supplement Nutrition advice
- 35. 12/24/2025 35 REFERENCE Food andnutrition technical assistance III project WHO. Guideline: Updates on the management of severe acute malnutrition in infants and children. Geneva: World Health Organization; 2013 MEDSTAR Clinical guide and synopsis 2ND EDITION PEDIATRICS.
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