128. Assessment Of Severe Acute Malnutrition

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128. Assessment Of Severe Acute Malnutrition

 

 

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Syllabus

Acknowledgements……………….Vi
Foreword………………vii
List of Contributors…………..vii
Acronyms and Abbreviations…………..ix
CHAPTER 1: Background……………………1
1.1. Severe Acute Malnutrition (SAM) in Nigeria……………..2
1.2. Integrated Management of Acute Malnutrition (IMAM) approach……………3

CHAPTER 2: Assessment of severe acute malnutrition………….5
2.1. Definition of severe acute malnutrition…………6
2.2. Inpatient admission criteria…………….6
2.3. Nutritional Assessment……………….7
2.3.1. Measuring MUAC……………….7
2.3.2. Checking bilateral oedema and Grading……………8
2.3.3. Measuring Weight……………..8
2.3.4. Measuring Length/Height………………9
2.3.5. Determining Weight- for-Height/length Z-Score…………10
2.4. Initial clinical assessment…………..12
2.5. Medical complications in patients with SAM…………12
2.6. Appetite test……….13
2.6.1. How to do Appetite Test………..13
2.6.2. Interpretation of Appetite Test…………..14

CHAPTER 3: Principles of Inpatient care………………15
3.1. Phases of Inpatient Care for Children 6-59m………….16
3.1.1. Stabilization Phase……………16
3.1.1.1 Dehydration in marasmic patients…………..17
3.1.1.2 Shock…………….23
3.1.1.3 Septic (Toxic) shock…………..24
3.1.1.4 Absent bowel sounds, gastric dilatation and intestinal splash………26
with abdominal distension
3.1.1.5 Heart Failure…………….27
3.1.1.6 Correct electrolyte………………29
3.1.1.7 Correct Severe Anaemia……………..30
3.1.1.8 Hypoglycemia…………….31
3.1.1.9 Hypothermia………………….33
3.1.1.10 Infection………..34
3.1.1.11Micronutrient deficiencies………..35
3.1.1.12 Feeding including Breastfeeding……………36
3.1.1.13 Addressing Associated Conditions……………..40

3.1.2. Transition Phase………..46
3.1.2.1. Catch-up Growth Feeding………46

3.1.3 Rehabilitation Phase…………..52
3.2 Infants <6months with SAM…………..54

CHAPTER 4: Organization of Inpatient Facility (IPF)………63
4.1. Admission ward…..64
4.2. Roles of Service providers…………….64
4.2.1. Doctors…………..64
4.2.2. Nurses…………….65
4.2.3. Dietitians and Nutritionists………..65
4.2.4. Pharmacist……………….65
4.2.5. Records Officer……………65
4.2.6. Medical Social WorkersCommunity Health Extension workers/
Community Health Officers…………65
4.3. Records…………66
4.3.1. Malnutrition record books…………..66
4.3.2. Admission and monitoring charts………66
4.4. Medicines………………66
4.4.1. Routine first line………………66
4.4.2. Alternative and supplementary medicines………….66
4.5. Equipment and supplies…………….67
4.5.1. Anthropometric tools………………67
4.5.2. Kitchen equipment and supplies…………..67
4.5.3. Therapeutic foods and other materials………….67
CHAPTER 5: Failure to respond to treatment…………68
5.1. High Mortality…………69
5.2. Low weight gain during rehabilitation phase……..70
5.3. Re-feeding syndrome……………72
CHAPTER 6: Transfer to Outpatient Therapeutic Program (OTP)………74
6.1. Transfer criteria for rehabilitation in OTP…………..75
6.2. Two way referral system……………75
6.3. Follow-up at OTP……………76
6.4. Discharge criteria………….76


CHAPTER 7: Monitoring quality of care…………77
7.1. Definition of terms…………78
7.2. Performance indicators……….81
7.3. Mortality audit…………….82
7.4. IPF Monthly reporting…………..82
7.5. Categories for report writing……………..83
7.6. IPF Supervision by relevant agents…………..84

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