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2023 WHO recommendations for treatment of severe wasting in 6-59 months age group.

This question was posted the Management of wasting/acute malnutrition forum area and has 3 replies.

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Barbagallo Mario-David

Medecins Sans Frontieres Nutrition Advisor

Normal user

3 Apr 2024, 09:54


I have a question after reading the following element in 2023 WHO recommendations for treatment of severe wasting in 6-59 months age group: 

Infants and children 6-59 months of age with severe wasting and/or nutritional oedema
who are enrolled in outpatient care should be given ready-to-use therapeutic food (RUTF) at a quantity that will provide:
• 150-185 kcal/kg/day until anthropometric recovery (WHZ ≥ -2 SD and MUAC ≥125mm) and resolution of nutritional oedema (previous recommendation was to give 150-220 kcal/kg/day)
• 150-185 kcal/kg/day until the child is no longer severely wasted and does not have
nutritional oedema, then the quantity can be reduced to provide 100-130

Regarding the proposed quantity reduction when the child reaches MAM anthropometric + odema resolution would we give the whole quantity in the form of RUTF or would we apply what is recommended in the section of the management of MAM where same quantity is suggested but with a max of 60% to be given in the form of SFF. 

thanks a lot for your answer. 

Allison Daniel

Consultant, WHO

Normal user

3 Apr 2024, 15:08

Thanks very much for this question.

In this case, the quantity of RUTF should be given to provide the full 100-130 kcal/kg/day, until anthropometric recovery (recommendation B10). The quantity should not be reduced to 40-60% which applies to infants and children with moderate wasting who require SFFs (recommendation B16), rather than infants and children who have been enrolled in outpatient care for severe wasting and/or nutritional oedema.

If this is unclear, please let me know and I can explain further.

Indi Trehan

Normal user

3 Apr 2024, 15:08

This should be provided as RUTF.

Marie McGrath


Frequent user

3 Apr 2024, 20:50

This is a great question, Barbagallo, as I have heard several others ask it too. Nicely clarified by Indi and Allison. Related to this, some have asked, why the difference in recommendations for moderately wasted children within the same guideline? My understanding is that this reflects that not all moderately wasted children are the same and that anthropometric criteria are a crude indicator of risk, that does not distinguish them.  A child who is now 'moderately wasted' having been severely wasted and is recovering, will likely have experienced a greater 'insult' to their wellbeing than a child who is moderately wasted but never descended further.  On a practical front too, keeping on RUTF for the entire recovery of a wasted child makes for more feasible implementation.  Just thought I'd share these thoughts promoted by this exchange.

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