Hi

In management of acute malnutrition, a child with complications whether mam is Sam is managed as an inpatient.

If the TFC are also providing something similar to inpatient care then admission is necessary if their are complications.

For this reason imam management requires a team that includes a clinician, nutritionist,nurse, occupational therapist and others who are trained in imam.

They will be able to triage and diagnose whether inpatient ,tfc, or outpatient management bwill be suitable. 

It's therefore important to advise vthe caregiver to take the child bto the nearest hospital and from their refferals are made.

Thanks Dr Nancy for your response

the child should be treated in TFC because of complications and distance from

health insitutions

Hi Mohammed,

I will try to answer your questions one by one. The patient you are describing falls under Moderately Acute Malnourishment (MAM). Therefore, this child should be admitted to Targeted Supplementary Feeding Program (TSFP) for MAM.

When the resources are available, all MAM cases undergo a medical check by a trained clinician or a qualified health provider like a nurse.  

MAM with medical complications which are specifically defined as MAM with medical complications and/or with no appetite (determined by history taking or even an appetite test using RUSF to confirm at the clinic level) or with other IMNCI danger signs require inpatient care or stabilization center care. 

Medical complications include hypoglycemia, hypothermia, infections, diarrhea and dehydration, shock, very severe anemia, cardiac failure, severe dermatosis, severe Vitamin A deficiency, and corneal ulcerations.

What eye signs did you spot that helped you conclude that the patient has Vitamin A deficiency?  Signs can range from the milder stages of night blindness and Bitot spots to the potentially blinding stages of corneal xerosis, ulceration, and necrosis  (keratomalacia).

The diagnosis of illnesses is quite straightforward for MAM cases, and they do not need special protocols for the management of medical complications10. The IMNCI protocols should be used.

The diagnosis of illnesses is quite straightforward for MAM cases, and they do not need special protocols for the management of medical complications10. The IMNCI protocols should be used.

Regardless, refer him to the nearest health facility that can provide a medical check-up and treatment if no ITP or SC is available. ITP's and SC's sometimes makes exemptions for patients who comes from distant and remote villages with limited access to health services.
 

References:

1. WHO. (n.a.). Vitamin A deficiency (who.int)

2. WHO (2002). Training course on the management of severe malnutrition. Geneva: WHO. http://www.who.int/nutrition/publications/malnutrition/en/ index.html.

3. MOH GOSS. (20117). CMAM Guidelines. https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/cmam_guidelines_book_print.pdf

Hi Mohammed,

Any child with a danger sign should be referred to hospital irrespective of their nutritional status (e.g. see IMCI danger signs). A child with SAM or MAM may be treated in a specialised nutritional stabilisation / rehabilitation ward or in a paediatric unit depending on your national guidelines / hospital policy. Please consult your relevant national guidelines for details.

Any child with eye signs should be given age appropriate doses of vitamin A as an emergency (see national protocols). If the location is a long way from hopsital or transport may be delayed, then a clinician (if available) should consider giving this prior to transfer to hospital.