Protocol for the Management of Acute Malnutrition

Total Page:16

File Type:pdf, Size:1020Kb

Protocol for the Management of Acute Malnutrition REPUBLIC OF RWANDA MINISTRY OF HEALTH PROTOCOL FOR THE MANAGEMENT OF ACUTE MALNUTRITION FEBRUARY 2018 Protocol for the Management of Acute Malnutrition MINISTRY OF HEALTH Protocol for the Management of Acute Malnutrition 2 Protocol for the Management of Acute Malnutrition FEBRUARY 2018 Protocol for the Management of Acute Malnutrition 3 Protocol for the Management of Acute Malnutrition 4 CONTENTS Contents.........................................................................................................................................25 List of tables ..................................................................................................................................79 List of boxes ..................................................................................................................................810 List of figures .................................................................................................................................810 Acronyms and abbreviations ........................................................................................................911 Preface ........................................................................................................................................1113 Acknowledgements......................................................................................................................1214 1. Pathophysiology of severe acute malnutrition (SAM) .....................................................1416 2. Definition of Severe Acute Malnutrition ...........................................................................1819 3. Management in the Community.......................................................................................2121 3.1 Community engagement ................................................................................................2121 3.2 Community screening .....................................................................................................2222 3.3 Home visits ......................................................................................................................2323 4. Triage at the health facility ..............................................................................................2525 4.1 The appetite test..............................................................................................................2525 4.1.1 The observed appetite test .............................................................................................2525 4.1.2 Why to do the appetite test? ...........................................................................................2525 4.1.3 How to do the appetite test.............................................................................................2626 4.2 Medical history and examination.....................................................................................2727 4.2.1 Take the history ...............................................................................................................2827 4.2.2 Examine the child.............................................................................................................28 4.3 Decision from triage criteria on whether to treat as an in- or outpatient .........................2929 4.4 Classification of nutritional oedema..................................................................................3130 4.5 Transport of sick patients.................................................................................................3131 4.5.1 IPF ...................................................................................................................................3231 4.5.2 OTP .................................................................................................................................3231 4.5.3 District Hospital Nutrition Officer (focal point) and Emergency Department ..................3231 5. Outpatient management of SAM in children aged over 6 months ..................................3433 5.1 Tools for OTP ..................................................................................................................3433 5.2 Initial assessment............................................................................................................3534 5.3 Ensure decision-making for outpatient or inpatient care was appropriate during triage ...................................................................................................................3534 5.3.1 First priorities ..................................................................................................................3634 5.4 Medical management .....................................................................................................3635 5.4.1 Treatment to be given in the clinic ..................................................................................3635 5.5 Dietary treatment in outpatient care ...............................................................................3937 5.6 Monitoring and follow-up treatment as an outpatient .....................................................4239 5.7 Failure to respond to treatment as an outpatient.............................................................4542 5.8 End of outpatient care treatment ....................................................................................4744 5.8.1 Criteria for the end of treatment ......................................................................................4744 5.8.2 Procedures for the end of treatment ..............................................................................4845 6. Management of complications of severe acute malnutrition in children over 6 months of age ......................................................................................................5046 6.1 Emergency Triage Assessment and Treatment in hospital settings ...............................5046 6.1.1 Principles of ETAT+ .........................................................................................................5460 6.1.2 Shock ..............................................................................................................................5248 6.1.3 Dehydration but no shock ...............................................................................................5550 6.1.4 Hypernatræmic dehydration ..........................................................................................5953 6.1.5 Respiratory distress ........................................................................................................6561 6.1.6 Severe pneumonia .........................................................................................................6156 6.1.7 Congestive heart failure .................................................................................................6256 6.1.8 Anaemia ..........................................................................................................................6356 Protocol for the Management of Acute Malnutrition 5 6.1.9 Convulsions .....................................................................................................................6560 6.1.10 Hypoglycaemia ...............................................................................................................6606 6.1.11 Hypothermia ...................................................................................................................6761 6.1.12 Eye signs of vitamin A deficiency ....................................................................................6862 6.1.13 Candidiasis ......................................................................................................................6962 6.1.14 Parasitic infections ...........................................................................................................6963 6.1.15 Helminthiasis ...................................................................................................................7063 6.1.16 Persistent diarrhoea .........................................................................................................6470 6.1.17 Osmotic diarrhoea caused by carbohydrate intolerance (re-feeding diarrhoea) ...........7064 6.1.18 Cholera or very severe watery diarrhoea ........................................................................7164 6.1.19 Eye infections ..................................................................................................................7165 6.1.20 HIV ...................................................................................................................................7165 6.1.21 Tuberculosis ...................................................................................................................7265 6.1.22 Malaria .............................................................................................................................7266 6.1.23 Measles ..........................................................................................................................66.72 6.1.24 Meningitis .......................................................................................................................66.73 6.1.25 Otitis media ......................................................................................................................7367 6.1.26 Skin infections .................................................................................................................7367
Recommended publications
  • Newborn Care 2 Table of Contents
    Newborn Care 2 Table of Contents Your Newborn ............................................ 4 Baby Basics ............................................... 16 Preparing for Your Baby ................................. 4 Stools ................................................................. 16 What to Expect in the Hospital ....................... 4 Wet Diapers ..................................................... 16 Your Newborn ................................................... 5 Diapering .......................................................... 16 Bathing .............................................................. 17 Comfort and Bonding ............................ 7 Skin Care .......................................................... 17 Handling Your Baby ......................................... 7 Fingernail Care ................................................ 17 Interacting with Your Baby ............................. 7 Umbilical Cord Care ....................................... 17 Crying and Comfort ......................................... 7 Circumcision Care .......................................... 17 Bonding with Baby ............................................ 9 Infant Development ........................................ 10 Health and Safety ................................. 18 Baby Wearing .................................................. 11 Sleep Safety ....................................................... 18 SUID and SIDS ................................................ 18 Sleep..............................................................
    [Show full text]
  • Breastfeeding Matters
    Breastfeeding Matters An important guide for breastfeeding families ACKNOWLEDGEMENTS Best Start by Health Nexus would like to thank the Public Health Units of Ontario who supported the creation and development of this provincial resource and generously shared their resources and expertise. We would also like to thank the parents and the experts who provided input for this booklet. Final review was done by Marg La Salle, RN, BScN, IBCLC, and BFI Lead Assessor. The information in this booklet is current at the time of production but information can change over time. Every effort will be made to ensure the information remains current. Throughout this resource, gender-specific language such as “woman”, “women” and “mother” is used in order to accurately cite the research referred to. We intend these terms to refer to all childbearing individuals, regardless of their gender identity or sexual orientation. Funded by the Government of Ontario. Table of Contents SECTION 1 .......................... 3 SECTION 4 ........................ 27 The Importance of Breastfeeding Important Things to Know • Risks of Not Breastfeeding • Waking a Sleepy Baby • Your Breastfeeding Rights • Calming a Fussy Baby • The Baby-Friendly Initiative • Burping Your Baby • Making an Informed Decision • Growth Spurts • Family Support • Sore Nipples • Peer Support • Using a Pacifier (Soother) • Engorgement SECTION 2 ........................ 11 • Storing Your Breast Milk Helping Your Baby Get a Good Start • Skin-to-Skin SECTION 5 ........................ 33 • Safe Positioning
    [Show full text]
  • USIT Exam Answer
    American Board of Family Medicine 2018 IN-TRAINING EXAMINATION CRITIQUE BOOK This book contains the answers to each question in the In-Training Examination, as well as a critique that provides a rationale for the correct answer. Bibliographic references are included at the end of each critique to facilitate any further study you may wish to do in a particular area. Copyright© 2018 The American Board of Family Medicine, Inc. All rights reserved. Item 1 ANSWER: E A urine test for Legionella pneumophila antigen is the preferred method to confirm Legionnaires’ disease. This test is rapid and will only detect Legionella pneumophila antigen. A sputum culture is the gold standard for the diagnosis of Legionnaires’ disease but it requires 48–72 hours. A chest radiograph does not confirm the diagnosis but may show the extent of disease. Responding to antibiotic treatment does not confirm a specific diagnosis. Ref: Mercante JW, Winchell JM: Current and emerging Legionella diagnostics for laboratory and outbreak investigations. Clin Microbiol Rev 2015;28(1):95-133. 2) National Center for Immunization and Respiratory Diseases: Legionella (Legionnaires’ disease and Pontiac fever): Diagnosis, treatment, and prevention. Centers for Disease Control and Prevention, 2017. Item 2 ANSWER: C Risk factors for developmental dysplasia of the hip in infants include a breech presentation in the third trimester, regardless of whether the delivery was cesarean or vaginal. Other indications to evaluate an infant for this condition include a positive family history, a history of previous clinical instability, parental concern, a history of improper swaddling, and a suspicious or inconclusive physical examination.
    [Show full text]
  • Safer Swaddling
    Safer Swaddling Although swaddling has been practiced for years, recent studies show that swaddling for sleep can put your baby at risk of suffocation. If you have tried calming your baby and nothing has worked, you can try swaddling to settle your crying baby. What are the risks of swaddling? Swaddling can get in the way of Swaddling for sleep may result in mother- baby bonding and newborn sudden infant death feeding g Loose fabric can cover baby’s face and Skin-to-skin contact between mother and baby cause suffocation. has many benefits. It helps you develop your g If the baby becomes unwrapped, the fabric relationship with your baby, helps reduce your can become wrapped around baby’s neck and baby’s stress, promotes more restful sleep and cause strangulation. helps with breastfeeding. g The baby may roll onto his or her stomach and be unable to roll back . Tight swaddling can be risky g Babies wrapped in blankets or heavy fabrics g Tight swaddling can interfere with breathing can get too hot, which increases the risk of and can even lead to pneumonia. Your baby Sudden Infant Death Syndrome (SIDS). must have enough room for his or her chest g Sleeping with a baby on a bed or couch greatly to move. increases the risk of sudden infant death and g It can cause long-term hip problems. Your suffocation. This risk is even higher when a baby must have enough room to freely move baby is swaddled. the hips and legs. January 2016 When to stop swaddling baby When baby can roll or is able to unravel the wrap, it is time to stop swaddling because the loose fabric creates a suffocation or strangulation risk.
    [Show full text]
  • STRONG UNION Actor Gabrielle Union Urges Women Not to Put Off Breast-Cancer Screenings PG
    DOWNLOAD THIS ISSUE ON YOUR TABLET FOR FREE FROM THE APP STORE OR GOOGLE PLAY! October 2016 $4.95 CANCER RESEARCH CANINE MEN’S THERAPIES HEALTH OFFER 5 Key HOPE FOR HEALTHY Cancer Signs HUMANS BEAUTY pg. 13 PG. 34 The Deal With FOOD Chemical Peels FAMILY & pg. 16 PARENTING Tasty Apple Making Shots Dishes for Fall pg. 40 CHECKUP Less Scary pg. 23 Advances in Breast Cancer pg. 44 LIVING HEALTHY Workout Recovery Tips pg. 12 STRONG UNION Actor Gabrielle Union urges women not to put off breast-cancer screenings PG. 28 OCTOBER 2016 Contents FEATURES Pg. 28 Download WebMD Magazine You’ve Got for FREE on the App Store and a Friend Google Play. Gabrielle Union knows all too well the pain of breast cancer. She lost one of her closest friends to the disease in 2010. Today she’s dedicated to spreading the I HAVE TO word about the importance MAKE SURE of breast cancer screening. MY HEALTH“ “ IS GREAT—SO I’M AROUND TO HELP MY The Canine FAMILY. Connection Promising new research looks at how treatments used to help dogs with cancer could one day help humans with the disease. IN EVERY ISSUE Pg. 4 EDITOR’S NOTE TAKE 10 Sonequa Martin- Green of The Walking Dead shares how a family history of cancer spurred her to become a health activist. Plus, she reveals her favorite Pg. health advice and her 34 ultimate “cheat food.” Pg. Cover Photograph by Alexei Hay/Trunk Archive 49 W ebMD.COM 2 OCTOBER 2016 Contents OCTOBER 2016 HEALTHY START Pg.
    [Show full text]
  • Effective Analgesia Using Physical Interventions for Infant Immunizations
    ARTICLE Effective Analgesia Using Physical Interventions for Infant Immunizations AUTHORS: John W. Harrington, MD,a,b Stacey Logan, MD,a WHAT’S KNOWN ON THIS SUBJECT: Pain during routine infant Courtney Harwell, MD,a Jessica Gardner, MD,a Jessica immunization causes parental anxiety. Oral sucrose solutions are Swingle, BS,a Erin McGuire, MS,a and Rosemarie Santos, MDa effective pain-reduction strategies. Few studies have measured aDepartment of Pediatrics, Eastern Virginia Medical School, a combined strategy of a physical intervention along with sucrose Norfolk, Virginia; and bDepartment of Pediatrics, Section of to decrease the infant’s pain response. General Academic Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, Virginia WHAT THIS STUDY ADDS: We demonstrate that a physical, KEY WORDS nonpharmacological intervention called the 5 S’s (swaddling, immunizations, vaccines, pain management, infant, analgesia side/stomach position, shushing, swinging, and sucking) provides ABBREVIATIONS significant pain reduction with or without sucrose during routine 5S’s—swaddling, side/stomach position, shushing, swinging, and sucking 2- and 4-month vaccinations. ANOVA—analysis of variance IRB—internal review board This trial has been registered at www.clinicaltrials.gov (identifier NCT01368861). www.pediatrics.org/cgi/doi/10.1542/peds.2011-1607 abstract doi:10.1542/peds.2011-1607 BACKGROUND: To measure the analgesic effectiveness of the 5 S’s Accepted for publication Jan 11, 2012 (swaddling, side/stomach position, shushing, swinging, and sucking) Address correspondence to John W. Harrington, MD, Department of alone and combined with sucrose, during routine immunizations at Pediatrics, Children’s Hospital of The King’s Daughters, 601 Children’s 2 and 4 months.
    [Show full text]
  • Essential Newborn Care and Breastfeeding
    Promoting Effective Perinatal Care Essential Newborn Care and Breastfeeding Training modules WHO Regional Office for Europe 2002 EUR/02/5035043 30063 ORIGINAL: ENGLISH UNEDITED E79227 Keywords INFANT CARE INFANT, NEWBORN INFANT, NEWBORN, DISEASES – therapy BREAST FEEDING HEALTH PERSONNEL – education TEACHING MATERIALS EUROPE, EASTERN EUROPE COMMONWEALTH OF INDEPENDENT STATES © World Health Organization – 2003 All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. This document was text processed in Health Documentation Services WHO Regional Office for Europe, Copenhagen CONTENTS Page Preface............................................................................................................................................................i Introduction ...................................................................................................................................................1
    [Show full text]
  • Breast Refusal Or Difficulty Achieving Or Maintaining a Latch Protocol #9: Breast Refusal Or Difficulty Achieving Or Maintaining a Latch
    Protocol #9: Breast Refusal or Difficulty Achieving or Maintaining a Latch Protocol #9: Breast Refusal or Difficulty Achieving or Maintaining a Latch Breast refusal or difficulty achieving a latch can occur at any stage of breastfeeding and is not limited only to the early weeks of birth. Observation and Assessment delivery, nerve damage related to birth injury, anaesthesia, intravenous therapy, lengthy labour. Assess the baby for: • Medical condition, e.g., jaundice, dehydration, • Repeated inability to achieve or maintain a latch. hypoglycemia, sepsis. • Pushing away from the mother’s breast with arms • Neurological conditions affecting muscle tone, and legs. e.g., hypertonia, hypotonia, prematurity. • Arching and crying when brought to the mother’s • Abnormal nasal, oral, or facial structure, breast. e.g., narrowing or blockage of the nasal airway • Latching and sucking a few times, then letting the (choanal atresia), cleft lip/palate, other alterations in nipple slide out of the mouth. palatal structure, receding chin. • Refusal of one or both breasts. • Abnormal tongue, e.g., ankyloglossia, large or short tongue, tongue curling up to the roof of the mouth, Possible Contributing Factors tongue thrusting, decreased tongue peristalsis. or Causes With an abnormal tongue, the tongue may not be • Breast refusal or difficulty achieving a latch may be able to extend past the lower gumline and cup the mother and/or baby related. areola during breastfeeding. This can be assessed by pulling back slightly on the baby’s lower lip when Early Breast Refusal the baby is at the mother’s breast. There may also be dimpling of the cheeks or clicking/smacking 1.
    [Show full text]
  • Caring for Babies with Prenatal Substance Exposure
    CARING FOR BABIES WITH PRENATAL SUBSTANCE EXPOSURE Ministry of Children and Family Development Vancouver Coastal Region In partnership with Acknowledgements ACKNOWLEDGEMENTS 2nd Edition updated December 2003, Ministry of Children and Family Development (MCFD), British Columbia Radhika Bhagat, MN, RN, & Pam Munro, MSN, RN Review and Contributions: • Child Development Centre, Prince George: Linda Martindale, Physiotherapist, Carol Oosthizen, Speech & Language Pathologist • Foster Parents: Colleen Anderson, Lorraine Jamieson, Laura Lang, • Forest Cottage Coaching: Tanya Helton-Roberts, www.ForestCottageCoaching.com • Infant Development Program: Bonnie Barnes, IDP Consultant, Vancouver; Dana Brynelson, Provincial Advisor, Annie Wolverton, Regional Advisor, Lower Mainland. • Ministry for Children and Family Development, /Vancouver Coastal Region: Sandi Karmel, Resources Social Worker, Lyna Kiviste, Resources Supervisor • Sunny Hill Health Centre for Children: Janice Duivestein, Lois Woo, & Nicole Raftis, Occupational Therapists; Janet Schlenker, Clinical Paediatric Dietitian • Vancouver Coastal Health Authority: Leslie Cochrane & Laraine Michalson, Community Health Nurses, Sheway Program; Corinne Eisler, Anne Swann, Nutritionists; Sue Wastie, Speech & Language Pathologist; Tana Wyman, Dental Program Coordinator • University of BC: Paul Thiessen, M.C.,F.R.C.P,(C), Clinical Professor, Pediatrics Pictures: Lenora Marcellus, MSN, RN, Mitch Stringer, & MCFD Illustrations: Infant Development Program & Doug Quiring The 1st Edition of this guidebook
    [Show full text]
  • A Guide for Parents of Kids and Teens
    How to Choose and Build a Relationship with Your Child’s Pediatrician A Guide for Parents of Kids and Teens How to Choose and Build a Relationship with Your Child’s Pediatrician: A Guide for Parents of Kids and Teens Children are not just miniature adults. They are individuals with bodies and minds that are always growing. From infancy to the teen years, they will change physically, mentally and emotionally. Through it all, it’s important they get regular checkups and are cared for when sick or hurt. That’s where a pediatrician comes in. Pediatricians care for children of all ages and have the expertise to help parents give their children the right start to a healthy life. Table of Contents How to Choose a Pediatrician for Your Child .......................................................................... 3 When to See the Pediatrician ..................................................................................................... 5 What to Bring to the Pediatrician’s Office ................................................................................ 6 Kids and Throwing Up: Should Your Worry? ............................................................................... 7 How to Make Shots Less Stressful at the Pediatrician’s Office ................................................ 9 Antibiotics: What to Discuss with the Pediatrician ................................................................. 11 Family Medicine Cabinet Essentials ........................................................................................
    [Show full text]
  • Safer Sleep for My Baby Helping Parents and Caregivers Create a Safe Sleep Plan As Parents, You Make Many Decisions Every Day to Help Keep Your Child Healthy and Safe
    Safer Sleep for My Baby Helping Parents and Caregivers Create a Safe Sleep Plan As parents, you make many decisions every day to help keep your child healthy and safe. When it comes to sleep, your baby’s sleep environment is always important – day or night. Some sleep practices are safer than others. This pamphlet shares information about how to help make your baby’s sleep environment as safe as possible – so every sleep is a safer sleep. You and your health care provider can also discuss your infant’s sleep plan. For more information, see the resources at the end of this document. Make Every Sleep a Safer Sleep Place baby on their back to sleep Put your baby to sleep on their back for every sleep, whether it's naptime or nighttime. Use a firm mattress free of hazards Use a firm mattress made for babies with no bumper pads, pillows, heavy blankets, comforters quilts or toys. This will help keep their sleep space safe. Use a crib or bassinet The safest place for your baby to sleep is in their own Health Canada approved crib, cradle or bassinet when at home or traveling. Plan ahead when traveling, and make sure there is a safe sleep surface for your baby. Examples of other safe sleep surfaces are on the next page. Check out this Health Canada link for more information https://www.canada.ca/en/ health-canada/services/safe-sleep/cribs-cradles-bassinets.html. Breastfeed as much as possible One way to help prevent sleep-related infant death is breastfeeding – which helps boost a baby’s immune system.
    [Show full text]
  • Long-Term Outcomes of Substance Exposure After NAS
    Long-Term Outcomes of Substance Exposure After NAS Cindy Beckett, PhD, RNC-OB, LCCE, CHRC, LSS-BB Northern Arizona Healthcare-Director of Research & Research Compliance Co-Chair Arizona Task Force on Preventing Prenatal Exposure to Alcohol & Other Drugs 2016 Governor’s Task Force on Substance Abuse July 20,2016 Background and Significance • Nearly half of all women of childbearing age drink alcohol regularly • 25% of these women binge drink • Women 18-25, alcohol consumption 55.8%, binge drinking 31.8% • Nearly half of all pregnancies in AZ are unplanned • SAMHSA reported pregnant women ages (15-44)- 9.8% reported drinking alcohol during the past month, 4.1% reported binge use • 4.3% of pregnant women reported illicit drug use during the past month; ages (15-25) - 8% use, ages (26-44) - 1.6% Substance Use & NAS in Arizona • The rate of NAS has increased by 235% from 2008 to 2014 and 27% since 2013 • AHCCCS was the payer in 79% of the NAS cases overall, 2008-2014 • White, non-Hispanics made up 68% of the total number of NAS cases, 2008- 2014 • The rate of newborns exposed to narcotics has increased more than 218% since 2008 • AHCCCS was the payer in 76% of the newborns exposed to narcotics from 2008-2014 • White, non-Hispanics made up 52% of the total number of narcotic exposure cases (n=1,707), 2008-2014 and Hispanics composed an additional 28% (n=922) of cases • The number of newborns exposed to cocaine decreased by 76% between 2008-2014 and by 39% from 2013 to 2014 • The number of newborns with FASD increased by 67% from 2013-2014 •
    [Show full text]