Children with moderate acute malnutrition should be managed according to the nature of their problem using standard approaches. In other words having moderate malnutrition does not make the management of pneumonia or diarrhea any different from any other child. If the child has tachypnea, with decreased appetite, he/ she should be treated with cotrimoxazole or amoxicillin. If the child has has 6 loose watery stools, he/ she should be offered reduced osmolality ORS. Be aware that children with MAM are more likely to have sepsis, so be quick to use antibiotics. Supplementary food itself is not associated with any complications, it is simply micronutrient rich food. It can be offered to ill children with MAM. If you have a specific medical problem you are thinking about, please let us know.

How can we manage the moderate acute malnutrition with medical complications of 6-59 months children ? Should we manage such children in stabilization centers as we manage SAM with medical complications; or we need to manage such children by IMCI protocol in the pediatric ward/hospital ? We need to receive some answers based on the global practices/evidences for proper management process to include in the Integrated Management of Acute Malnutrition guideline.

Normally MAM is manage in the community based organizations where the affected child/children are put in SF programes this after stablization phase for hospitals or if identified during community assessment. If the child improves in hospitals where admitted with SAM is /are put to OTP programes but the SAM case can be managed in IPT group, although to manage the through OTP group more than IPT but if the case detororiet readmission is done.

I should think that any child with any form of malnutrition but with complications should be treated as a severe case such that they are initially treated in the impatient care until the complication stabilizes. After stabilization, then the child can be referred to OTP or SFP depending on their MUAC and or WFH measurements. Its usually important however, to discharge the child to OTP for a little while before they are referred to SFP. Summing it all up, complications in a malnourished no matter what category of malnutrition they are in, should not be treated as an outpatient or community based case as this would easily compromise the child's immune system making them vulnerable to subsequent infections that could in turn exacerbate the malnutrition condition to more severe cases. So, treating them as impatient case could minimize possibilities for or delay deterioration.

The concern is Moderate Acute Malnutrition with any of the medical complications. The questions is whether the MAM with medical complication should be treated in IPT as we treat SAM with medical complication or we need to use IMCI guideline to treat MAM with medical complication as we treat general children with medical problems. We need some global evidences/practices on this matter. There is a debate. one idea is as; MAM with medical complication should be treated in the IPT as we treat SAM with medical complications; second idea is as; MAM with medical complication should be treated by using IMCI guideline. We need to decide one approach as highlighted here and request appropriate suggestion.