Severe Childhood Acute Malnutrition Without Complications

Signs and Symptoms

Any Children with SAM who meet the following criteria:

• The child is > 6 months of age and weight 3kg
• Pitting oedema of ≤ +2
• The child is alert (not lethargic)
• The child has a good appetite and is feeding well
• The child does not have any danger signs and is clinically well

Treatment

General measures:

• Children with severe acute malnutrition without complications should be admitted in the Outpatient Therapeutic Program (OTP) and followed up every 2 weeks.
• Conduct appetite test in a quite separate area. The child passes the test if he/she eats at least one-third (1/3) of a packet of RUTF (92g).
• Conduct medical assessment

Pharmacological

• Antibiotics
• All children with SAM without complications should receive oral antibiotics.
• Amoxicillin is the antibiotic of choice in OTP and it given as shown in the table below:

Weight of the Child (kg)

Syrup 125mg/5ml Syrup 250mg/5ml Tablets 250mg < 2.0 62.5mg (2.5ml) every 8 hours 62.5mg (1.25ml) every 8 hours 62.5mg (1/4 tablet) every 8 hours 2.0-9.9 125mg (5ml) every 8 hours 125mg (2.5ml) every 8 hours 125 (1/2 tablet) every 8 hours 10.0-30.0 250mg (10ml) every 8 hours 250mg (5ml) every 8 hours 250mg (1tablet) every 8 hours >30.0 Give tablets Give tablets 500mg (2 tablets) every 8 hours

• If Amoxicillin is not available, use Cotrimoxazole according to IMCI protocol
• Do not give Vitamin A Supplementation to children with SAM in OTP
• Do not give Iron and Folic acid to children with SAM in OTP
• Children with diarrhea with mild and moderate dehydration should receive only RUTF and water.
• ORS contains high sodium and is inappropriate (and potentially fatal) for children with SAM.
• All children with severe dehydration they should be referred for inpatient care.
• Zinc should not be given in children on RUFT.

Antimalarial

• Lumefantrine/Artemether (LA) should only be prescribed if there is a positive diagnostic test.
• Refer to malaria section

Deworming

• All children in OTP should be dewormed using Albendazole or mebendazole as shown in the table below.
• If the child is transferred between OTP and NRU ensure that this dose is not repeated.

Age Albendazole Mebendazole <12 months None None 12 to 23 months 200mg single dose 100mg EVERY 12HRS for 3 days 24 to 59 months 400mg single dose 100mg EVERY 12HRS for 3 days

Nutritional management

• The nutritional treatment is managed in the home, with the children attending OTP sessions on a weekly basis to monitor the health and nutritional status and replenish

RUTF stocks.

• Ready to Use Therapeutic Food (RUTF) is used to treat patients with SAM in OTP.
• Amounts of RUFT to give are given in the table below:

Weight of Child (kg) Packets per Day Packets per Week 3.5-3.9 1.5 10 4.0 -4.4 1.5 11 4.5-4.9 1.75 12 5.0-5.9 2 14 6.0-6.9 2.5 17 7.0-7.9 3 20 8.0-8.9 3.25 23 9.0-9.9 3.75 26 10-11.9 4 28 ≥12 5 35