INTERIM NATIONAL GUIDELINES FOR COMMUNITY-BASED MANAGEMENT OF SEVERE ACUTE MALNUTRITION IN GHANA February 2010 INTERIM NATIONAL GUIDELINES FOR COMMUNITY-BASED MANAGEMENT OF SEVERE ACUTE MALNUTRITION IN GHANA TABLE OF CONTENTS Acknowledgements ...................................................................................................................................................... i Foreword ....................................................................................................................................................................... ii Acronyms and Abbreviations .................................................................................................................................. iii CHAPTER I: Introduction ..................................................................................................................................... 1 1.1 Acute Malnutrition as a Form of Undernutrition ..................................................................................... 2 1.1.1 What Is Undernutrition? ................................................................................................................. 2 1.1.2 What Is Acute Malnutrition? .......................................................................................................... 2 1.1.3 Assessing Acute Malnutrition ......................................................................................................... 2 1.2 Principles of the Management of SAM ....................................................................................................... 4 1.2.1 Community Outreach ....................................................................................................................... 5 1.2.2 Outpatient Care for Children 6-59 Months ................................................................................ 6 1.2.3 Inpatient Care for Children 0-59 months .................................................................................... 6 1.2.4 Supplementary Feeding of Children 6-59 Months and Pregnant and Lactating Women With MAM.................................................................................................................................... 6 CHAPTER II: Community Outreach .................................................................................................................. 8 STEP 1: Community Assessment ........................................................................................................................ 9 STEP 2: Formulation of Community Outreach Strategy ............................................................................... 9 STEP 3: Developing Messages and Materials ................................................................................................... 9 STEP 4: Community Mobilisation and Training ......................................................................................... 10 STEP 5: Case-Finding and Referral of New Cases With SAM ................................................................ 10 STEP 6: Follow-Up of Children With SAM ................................................................................................ 11 STEP 7: Linking With Other Community Services, Programmes and Initiatives ................................. 12 STEP 8: Continued Community Mobilisation (as in Step 4) .................................................................... 12 CHAPTER III: Outpatient Care for the Management of SAM Without Medical Complications ..... 14 STEP 1: Screening Children for SAM ............................................................................................................ 15 STEP 2: Admission Criteria .............................................................................................................................. 16 Admission Procedure ................................................................................................................................ 16 STEP 3: Medical Assessment and Decision-Making for Treatment ........................................................ 18 Appetite Test With RUTF .................................................................................................................... 18 STEP 4: Referral to Inpatient Care.................................................................................................................. 19 Upon Admission ....................................................................................................................................... 19 At Follow-On Visits, Referral Based on Action Protocol................................................................ 20 STEP 5: Medical Treatment in Outpatient Care .......................................................................................... 22 New Admission ......................................................................................................................................... 22 Routine Medical Treatment for New Admission .............................................................................. 22 Vaccination Schedule Update ................................................................................................................ 23 STEP 6: Dietary Treatment in Outpatient Care ........................................................................................... 24 INTERIM NATIONAL GUIDELINES FOR COMMUNITY-BASED MANAGEMENT OF SEVERE ACUTE MALNUTRITION IN GHANA Quantities of RUTF to Provide ............................................................................................................ 24 Feeding Procedure ..................................................................................................................................... 24 STEP 7: Counselling, Health, Nutrition and Hygiene Education ............................................................ 25 Upon Admission ....................................................................................................................................... 25 At Follow-On Visits ................................................................................................................................ 25 STEP 8: Individual Monitoring During Follow-On Visits at the Health Facility ................................ 26 Anthropometry .......................................................................................................................................... 26 History and Physical Examination ........................................................................................................ 26 Follow-Up Action ..................................................................................................................................... 26 STEP 9: Follow-Up Home Visits for Children Requiring Special Attention........................................ 26 STEP 10: Discharge Criteria ............................................................................................................................. 27 Discharge Procedures ............................................................................................................................... 27 CHAPTER IV: Inpatient Care for the Management of SAM With Medical Complications for Children 6-59 Months ........................................................................................................................................ 29 4.1 Admission Criteria ........................................................................................................................................ 30 4.2 Admission Procedure.................................................................................................................................... 31 4.3 Stabilisation Phase ........................................................................................................................................ 31 4.3.1 STEP 1: Treat/Prevent Hypoglycaemia ................................................................................... 31 4.3.2 STEP 2: Treat/Prevent Hypothermia ....................................................................................... 32 4.3.3 STEP 3: Treat/Prevent Dehydration ........................................................................................ 33 4.3.4 STEP 4: Correct Electrolyte Imbalance ..................................................................................... 34 4.3.5 STEP 5: Treat/Prevent Infection ............................................................................................... 34 4.3.6 STEP 6: Correct Micronutrient Deficiencies ........................................................................... 35 4.3.7 STEP 7: Start Cautious Feeding ................................................................................................. 36 4.3.8 Monitoring During the Stabilisation Phase .............................................................................. 40 4.3.9 Criteria to Progress from the Stabilisation Phase to the Transition Phase ........................ 40 4.4 Transition Phase ............................................................................................................................................ 40 4.4.1 Transition Using RUTF............................................................................................................... 40 4.4.2 Transition for Special Cases (Children Who Cannot Consume RUTF) .......................... 42 4.4.3 monitoring During the Transition Phase ................................................................................