Laboratory-confirmed tuberculosis through Mycobacterium tuberculosis culture is the gold standard, but children with SAM often do not produce suitable sputum samples, and culturing the bacteria is a lengthy procedure.
Only about 15 percent of children with SAM have medical complications that require inpatient treatment Collins, Sadler, and others The guidelines state that treatment programs for SAM should achieve a CFR of less than 10 percent, a recovery rate greater than 75 percent, and a defaulter rate of less than 15 percent Sphere Project In many CMAM programs, RUTFs are a major contributor to the cost of treatment, constituting 24 percent to 43 percent of the total cost of treatment per child Puett and others ; Tekeste and others High-quality studies using quality-improvement methods and observational designs, as well as qualitative research and program reports, are all important investigative approaches.
Improved coordination with agencies can assist in producing alternative ways to manage MAM.
Studies in a broader range of contexts and including long term follow up are needed. Additionally, with the promotion and use of locally produced products, alternate routes for cost-effectiveness can be explored; especially in combination with community-based delivery approaches and increases in TSFP coverage.
The model uses community health workers or volunteers CHWs or CHVs to actively find cases of wasting within the community. Studies in Malawi Wilford, Golden, and Walker and Zambia Bachmann examining the costs of CMAM compared with hypothetical simulations of no care both find CMAM to be cost-effective and on par with other child health interventions, including universal salt iodization, iron fortification, immunization, and micronutrient fortification.
Global What we know: The majority of SAM and MAM trials follow children for a short period and only report on changes during the intervention, providing little insight into what happens after treatment.
An evidence review found eight reports describing outcomes for single cohorts of children with edema treated in the community for SAM WHO The treatment protocol for children with edematous malnutrition is largely the same but with several important caveats outlined in the WHO guidelines WHO Since the early s, the products used to deliver nutrients for management of SAM and MAM and the approaches used to target and deliver them have been evolving rapidly.
The WHO guidelines WHO recommend that children should be enrolled and discharged from treatment using the same mode of classification.
Of this amount, approximately 35 percent of the costs were for consumables, which is in line with the costs of other estimates for RUTFs in the treatment of SAM Bhutta, Das, Rizvi, and others Children who were admitted based on their edema should be discharged based on the measurement routinely used in the program.
One systematic review of antibiotics as part of SAM management concludes that the evidence for the addition of antibiotics to therapeutic regimens for uncomplicated SAM is weak and urges further efficacy trials Alcoba and others We prospectively surveyed children aged months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme.
A Decision Tool for Emergencies. Recent mortality rates and cause of death data for newborns, infants, and children are incorporated, by country, using estimates established by the Child Health Epidemiology Group CHERG.
The meta-analysis was conducted using RevMan 5. Treatment of Edematous Acute Malnutrition Edematous acute malnutrition, referred to as kwashiorkor, is a form of acute malnutrition characterized by stunted growth, generalized edema, dermatologic manifestations, and hepatic steatosis Garrett The centralized nature of the facilities means that the difficulties patients face in transport can result in delayed presentation of cases and lower coverage rates.
At each clinic visit growth will be measured. The optimal setting for managing children with SAM who have mild to moderate edema remains unclear; these children may be treated in outpatient settings or referred to inpatient facilities, depending on the protocol of particular programs.
HIV-positive mothers should receive ART or infants should receive prophylaxis, and mothers should be encouraged to breastfeed exclusively for six months and continue for up to two years Jones and Berkley ; WHO The review focused on children under five years in low- and middle-income countries.
There is also a need for programs to standardize enrollment and discharge criteria, and to measure and report program outcomes consistently so that program impacts can be tracked over time and compared between sites GNC ; Hall, Blankson, and Shoham ; Lenters and others These systematic reviews collated evidence related to treatment of SAM, including criteria for identifying SAM, discharge, follow-up, treatment of HIV-positive children with SAM, appropriate hydration, and treatment of infants younger than age six months.
While food supplementation is necessary in humanitarian emergencies and chronic food insecurity contexts, acute malnutrition is not confined to situations of conflict or famine.
Because of the small number of studies with limited generalizability, as well as the costs and resistance risks associated with broad use of antibiotics, this topic requires immediate further investigation. The current scientific evidence base and programmatic expertise provide a foundation for making substantial strides toward reducing the prevalence of SAM.
Looking Forward Addressing Evidence Gaps for Effective Management Approaches to managing SAM have shifted dramatically since the early s, leading to improvements in coverage rates and treatment outcomes Collins, Dent, and others ; Hall, Blankson, and Shoham ; Lenters and others Globally, approximately 33 million children under five years of age are affected by moderate acute malnutrition (MAM), defined as a weight-for-height z-score (WHZ) between -2 and -3, and at least 19 million children under five by severe acute malnutrition (SAM), defined as a WHZ of.
Acute malnutrition is a continuum condition, but severe and moderate forms are treated separately, with different protocols and therapeutic products, managed by separate United Nations agencies.
The Combined Protocol for Acute Malnutrition Study (ComPAS) aims to simplify and unify the treatment of uncomplicated severe and moderate acute malnutrition (SAM and MAM) for children 6–59 months.
Apr 21, · BACKGROUND: Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM.
Chapter 11 Management of Severe and Moderate Acute Malnutrition in Children. Lindsey Lenters, Kerri Wazny, Moderate acute malnutrition (MAM), defined as weight-for-height 1 z-score Management of Severe and Moderate Acute Malnutrition in Children - Reproductive, Maternal, Newborn, and Child Health.
Management of Moderate Acute Malnutrition (MAM): Current Knowledge and Practice CMAM Forum Technical Brief: Recommendations for Counselling Caregivers with MAM Children on Appropriate use Management of Moderate Acute Malnutrition Moderate Acute.
Management of Moderate Acute Malnutrition (MAM): Current Knowledge and Practice. Nutritional Recommendations for the Management of Moderate Acute Malnutrition • Caregivers of children.Download