07 2011 ACF Guidelines + Annexes for the Integrated Management Of
Total Page：16
File Type：pdf, Size：1020Kb
ACF INTERNATIONAL GUIDELINES FOR THE INTEGRATED MANAGEMENT OF SEVERE ACUTE MALNUTRITION: IN- AND OUT-PATIENT TREATMENT GUIDELINES FOR THE INTEGRATED MANAGEMENT OF SEVERE ACUTE MALNUTRITION: IN- AND OUT-PATIENT TREATMENT Nutrition and Health Department ACF - International ACF-In Guidelines for the integrated management of SAM Legal Information 3 LEGAL INFORMATION Statement on copyright The protocols on the Management of Severe Malnutrition contained within this document are the copyright of Professor Michael H Golden and Dr Yvonne Grellety. These protocols can be reproduced provided that the source is credited and copyright to the material remains vested in the original owners. The material must not be abstracted, edited or changed without the written permission of the copyright holders. Those sections (indicated in ) that are not the property of Professor Michael H Golden and Dr Yvonne Grellety but ACF can also be reproduced. Where this is the case mention must be made that the results were obtained within the framework of collaboration with the ‘Charity’ and ‘Consultants’ and ACF is prominently credited. © Professor Michael Golden and Dr Yvonne Grellety Non-responsibility clause The present document aims to provide public access to information concerning the actions and policies of Action contre la Faim International Network and the best practice advice of Professor Michael Golden and Dr Yvonne Grellety. Our objective is to disseminate information that is accurate and up-to-date on the day it was initiated. We will make every effort to correct any errors that are brought to our attention. However, the authors and ACF bear no responsibility for information contained in the present document. This information - is solely intended to provide general information and does not focus on the particular situation of any physical person, or person holding any specific moral opinion; - is not necessarily complete, exhaustive, exact or up-to-date; - sometimes refers to external documents or sites over which the authors and ACF have no control and for which the authors and ACF decline all responsibility; - does not constitute legal advice. The present non-responsibility clause is not aimed at limiting either the author’s or ACF’s responsibility contrary to requirements of applicable national legislation, or at denying responsibility in cases where this cannot be done in view of the same legislation. ACF-In Guidelines for the integrated management of SAM Acknowledgements 4 ACKNOWLEDGEMENTS The foundation for these guidelines grew out of the work done at the Tropical Metabolism Research Unit, Jamaica from 1956 to 1991. The work was funded by the University of the West Indies and the Wellcome Trust. The physiological and nutritional knowledge gained formed the basis for the WHO (1999) guidelines for the management of Severe Acute Malnutrition. The guidelines were first applied by Action Contre Le Faim (ACF) in 1994 in Rwanda and subsequently applied in many Emergency situations. The experience gained showed the shortcomings of the WHO guidelines which were then extensively revised. The revised version formed the basis for many National Protocols which were then evaluated by the authors. The subsequent evolution of the guidelines depended upon these field evaluations of actual programmes, analysis of the data, identification of problems and situations not adequately addressed by current versions of the guidelines, research undertaken by students of the University of Aberdeen and deliberation by the ACF Scientific Committee. The ACF Scientific committee (M. Golden, A. Briend, Y. Grellety, C. Prudhon and D. Bounie) was instrumental in the formulation, development and initial testing of RUTF. This permitted effective treatment at home and large scale implementation of the treatment of SAM in the community. The subsequent testing of the products was largely undertaken by Andre Briend with collaborators and the implementation in emergency settings spearheaded by Steve Collins of Valid International with Concern Worldwide and Save the Children UK. We gratefully acknowledge the contribution of the agencies, field staff and students to this latest incarnation (version 6) of the guidelines. In particular, Action Contre la Faim-France and Action Contre la Faim-International contributed to the earlier revisions or the WHO guideline and UNICEF (country and regional offices) MSF-France and the European Community contributed to the later revisions by supporting evaluations of the programmes in the field. ACF addition: Andrew Tomkins, Carlos Navarro Colorado, André Briend; Sophie Laurence; Beatrice Mounier and Alix Haentjens have also contributed to revise previous version and finalisation of this version. The Protocol for SAM management is in constant evolution. ACF is following closely the studies and research performed by partners and is active in developing new evidence. Many questions are still pending and ACF will regularly update the protocol following the evolutions. Some example of ACF studies on-going: - Studies on anthropometric measurement to better identify the most relevant criteria for detection, admission and discharge in the nutrition programme. - Systematic antibiotic in SAM children study in 2011-2012 (Central African Republic) - “Alternative protocol” research (possibility of reducing the amount of RUTF given to the beneficiaries in OTP in the latest phase of treatment). Any errors or omissions are the responsibility of the Authors. ACF-In Guidelines for the integrated management of SAM Contents 5 CONTENTS ACRONYMS _________________________________________________________________ 10 GLOSSARY __________________________________________________________________ 12 INTRODUCTION ___________________________________________________________ 13 1. The nature of malnutrition ............................................................................................................. 13 2. Treatment of disease in the malnourished is different from the normally nourished ....... 14 3. Prevention of complicated malnutrition ...................................................................................... 15 ORGANISATION of an IMAM programme _____________________________________ 16 HIV, TB and SAM __________________________________________________________ 17 COMMUNITY ASPECTS OF IMAM ____________________________________________ 18 1. Community involvement ................................................................................................................ 18 2. Planning the community programme .......................................................................................... 18 3. Community awareness and involvement .................................................................................... 19 4. Staff at community level ................................................................................................................ 20 • Existing health staff ___________________________________________________________________ 20 • Outreach Health workers ______________________________________________________________ 20 • Volunteers __________________________________________________________________________ 20 • Selection of volunteers ________________________________________________________________ 21 5. Screening, referral for treatment, follow-up and education .................................................... 22 • Screening ___________________________________________________________________________ 22 • Active case finding in the community ____________________________________________________ 22 • Constraints __________________________________________________________________________ 23 • Tools ______________________________________________________________________________ 24 • Data collation ________________________________________________________________________ 24 • Passive screening in health structures, in the OPD and the Emergency room at hospital/health centre level ________________________________________________________________________________________25 • Other opportunities for screening _______________________________________________________ 25 • Follow-up ___________________________________________________________________________ 25 • Health Education, Mother-to-mother support with emphasis on breastfeeding ___________________ 26 TRIAGE PROCEDURE ______________________________________________________ 28 1. Definition of SAM – Criteria for admission to IMAM programme ........................................... 29 2. The appetite test and flow of patient ........................................................................................... 31 • Why to do the appetite test? ___________________________________________________________ 31 • How to do the appetite test? ___________________________________________________________ 31 • The result of the appetite test ___________________________________________________________ 32 ACF-In Guidelines for the integrated management of SAM Contents 6 3. Medical complications (IMCI) ........................................................................................................ 34 • Specificity for HIV/TB patient ___________________________________________________________ 35 4. To summarise ................................................................................................................................... 36 TRANSPORT OF SICK PATIENTS ____________________________________________ 38 OUT-PATIENT TREATMENT PROGRAMME ___________________________________