Adolescents and Adults with Severe Malnutrition Without Complications

Clinical Description

MEDICAL TREATMENT

• Assess for associated or underlying medical conditions such as HIV, TB, malignancy or anaemia and provide treatment or refer for treatment according to the national guidelines.

Non-pharmacological

• All patients who fail the appetite test i.e., does not eat at least half a sachet of RUTF, should be referred to in-patient care.
• Patients who pass the appetite test should be given 3 sachets of RUTF and 300 grams of likuni phala per day or 3 sachets of RUTF and 300 grams of CSB++ (Corn Soya Blend) to consume at home provided they have someone to support him or her.
• RUTF and likuni phala or CSB++ should not be shared with family members; they should not be discontinued if the patient has diarrhea and they should be given in addition to the family food.

Note: Severely undernourished pregnant and lactating women up to 6-month post-partum should not be treated with RUTF. Provide the client with only likuni phala or CSB ++ or other supplementary food that meets recommended standards. RUTF contains high doses of vitamin

A, above the recommended 10,000 IU per day. High doses of vitamin A can cause teratogenic effects in early pregnancy.

• Encourage pregnant and lactating women to meet their additional energy requirements by eating other home-prepared nutritious foods.
• Adolescents and adults should be transitioned from severe undernutrition without medical complications to moderate undernutrition if the criteria indicated in the table below are met.

Group BMI BMI-for- age

MUAC Weight 12–14 years ≥ –3 ≥ 160 mm

Gains 10% or more of his/her body weight 15–18 years ≥ –3 ≥ 185 mm ≥ 19 years ≥ 16.0 ≥ 190 mm

Pregnant women and lactating women up to 6 months post- partum ≥ 190 mm

Gains at least 2.0 kg per month