Management of Malnutrition in Children Under Five Years
Management of Moderate Acute Malnutrition in Children Under Five Years
Supplementary Feeding Programs
Summary of Key Steps for Out-patient treatment:
- The decision to implement a Supplementary Feeding Program is usually based on raised prevalence of acute malnutrition among children under five and the presence of aggravating factors such as poor food security in the general population, disease epidemic and raised mortality (severity of a crisis). The justification for intervention, the objectives, the target groups and a viable exit strategy must be defined at the start of the program.
- Patients from admission that fulfil the criteria for MAM and do not have medical complications should be registered and all their information recorded in the Client Card [Front | Back] including the target weight for discharge (WHO/NCHS table).
- The ration for one child should provide a maximum of 1000 to 1200kcal/person/day and 10-12% of energy from protein, The following foods are used:
Local foods such as rice, beans and locally-produced vegetables should be the basis for supplementary rations. A fortified food or micro-nutrient supplement (e.g. sprinkles) should be added where the minimum required diet can not be met using available resources.
Blended cereals can provide 350-400 Kcal per 100gr of dry product. Combined mineral and vitamin mixes should be added to blended cereals that are not pre-fortified. The most common example of blended cereal is the Corn Soya Blend. Supplementary porridges [view consistency of porridge] can be made at home by mixing one part of blended cereal with three parts of water and by cooking the mixture until it has boiled and the consistency has thickened. A dry-food ration consists of blended cereals, oil and sugar that are not pre-mixed. A pre-mixed ration is when blended cereals are mixed with oil and sugar prior to distribution. Pre-mixing increases the logistic requirements and can reduce the life-shell of the ration (around two weeks when pre-mixed).
High-energy and protein biscuits are usually provided only in the onset of an emergency. They should not be given priority over locally-available products and should be avoided in the long-term.
- A dry-food ration can be provided weekly, fortnightly or monthly depending on resources, needs of target population and access to SFP sites. Food should be distributed by weight using a balance or calibrated container and, wherever possible, should be transported home by mothers in their own containers. A wet-food ration may place an economic burden on the caregiver that has to come on a daily basis, as well as on the facility because of increased logistic demands.
- Caregivers should bring their admitted child for surveillance through weighing, Mid-Upper Arm Circumference (MUAC) screening,
oedema checking and assessment of standard clinical signs.
MUAC Resources - Sources for MUAC Straps
Supplementary feeding site - what you need at a glance
- Infant/child length-height measuring board
- Scale, infant spring-type 25 kg x 100g
- Weighing trousers
- Mid-Upper Arm Circumference (MUAC) tape
- Scale, infant, clinic beam type, 16kg x 10g
Registration and recording equipment:
Feeding and cooking equipment for wet supplementation feeding (Oxfam Kit 2)
Mixing and distributing equipment for dry supplementary feeding (Oxfam Kit 3A)
- Routine medicine table
- Summary Admission - Discharge Criteria Table
- NCHS/WHO reference table
6 March, 2016