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What to do when tx for SAM is impossible but MAM possible?

This question was posted the Management of wasting/acute malnutrition forum area and has 1 replies.

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Brent Scharschmidt

Malnutrition Coordinator

Normal user

2 Sep 2010, 00:19

Are there protocols that exist for situations where programs targeting severe acute malnutrition are impossible due to HR limitations, but a program for distribution of dry rations to moderate kids is feasible? There's currently a food crisis in western Burma with a number of acutely malnourished children. There are no clinics/hospitals in the area. We have developed simple protocols for treatment of MAM in nearby areas that we should be able to implement without much difficulty (biweekly distribution of dry rations) but with no clinics and very few experienced health workers we lack the resources to do inpatient feeding for severe cases. RUTF/PlumpyNut is also not available due to import restrictions, and local production is unfeasible. Lacking other options, should severe kids at least be entered into the moderate program? Are there protocols for other treatment approaches for severe kids that don't require around-the-clock management or a feeding center? I realize this is the exact situation RUTF is designed for, unfortunately that option seems impossible for us. Thanks for the advice.

Suranjeen Prasad Pallipamula

Unit Coordinator / Technical Advisor

Normal user

2 Sep 2010, 10:06

Dear Brent, Of all the SAM 'kids' around 20% will be classified as sick and 80% as not sick. Once you are able to make this segregation, the 80% can be easily taken care with the MAM protocols of double rations you follow. Though I would recommend a weekly review of them to ensure that they are not slipping into the sick category. The crucial part is to teach a local health staff on screening those with SAM for sickness. the screening would include sorting 'kids' who are sick as per IMCI norms, looking for bi-pedal oedema and administering an appetite test (fail = sick). the appetite test is simple and can be found on the web. if your health staff are IMCI trained, then you have nothing much to worry. For those who are sick (this will be a relatively small number), you have to get them seen by a trained doctor who understands SAM. A health professional who does not know about SAM could do more harm than good. Regards

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