Management of uncomplicated severe acute malnutrition in children in resource-limited countries

Authors: TREHAN, INDI - University Of Washington; MANARY, MARK - Children'S Nutrition Research Center (CNRC)

Submitted to: UpToDate
Publication Type: Book / Chapter
Publication Acceptance Date: 11/15/2021
Publication Date: 12/28/2021
Citation: Trehan, I., Manary, M.J. 2021. Management of uncomplicated severe acute malnutrition in children in resource-limited countries. UpToDate. Available at: https://www.uptodate.com/contents/management-of-uncomplicated-severe-acute-malnutrition-in-children-in-resource-limited-countries

Interpretive Summary:

Technical Abstract: Community-based management of acute malnutrition (CMAM) is a structured system of outpatient care for children with uncomplicated severe acute malnutrition (SAM). Key components of CMAM programs are provision of a therapeutic food that is of high nutritional quality and has minimal spoilage, known as ready-to-use therapeutic food (RUTF), and regular follow-up at home or in decentralized health centers, ideally in proximity to where children live by trained community-based health workers. Using this strategy, more than 90 percent of children with SAM can be treated as outpatients, provided that the child has a good appetite and no obvious acute infection or other medical complications. Children with anorexia or complications are initially treated in inpatient programs but are transferred to outpatient care as soon as possible. Over the past two decades, an increasing number of countries and relief agencies have adopted CMAM with remarkable success, leading to widespread acceptance and dissemination of this approach worldwide. Where CMAM is available, nutritional recovery rates can be expected to regularly exceed 80 percent and case fatality rates can be expected in the 5 to 10 percent range, or even better in particularly well-functioning programs. Effective CMAM requires the presence of trained staff, reliable supply chains for RUTF and medications, and the possibility of referral for inpatient care if needed, and can generally be accomplished by appropriately trained and resourced community health workers. Because of the increasing availability of RUTF, CMAM has mostly replaced the historical system of universal inpatient management, which was plagued by limited access, poor outcomes, and high costs. There certainly remains an important role for hospitalization for children with complicated SAM. However, CMAM allows most acutely malnourished children to "skip" the inpatient phase of treatment and allows for an orderly transition of care once children with complicated SAM have recovered sufficiently.