PE10.1-5 | Severe Acute Malnutrition — Summary & Reflection

KEY TAKEAWAYS

Severe Acute Malnutrition is diagnosed by any ONE of: weight-for-height z-score < −3 SD, MUAC <11.5 cm, or bilateral pedal oedema. Clinical types are marasmus (wasting, no oedema), kwashiorkor (oedema + protein deficit features), and marasmic-kwashiorkor (wasting + oedema). Management follows the WHO 10-step protocol in two phases: stabilisation (days 1-7, F-75 at 100-130 mL/kg/day, treating hypoglycaemia with 10% dextrose 5 mL/kg, hypothermia with kangaroo care, dehydration with ReSoMal — NOT standard ORS, and empirical antibiotics) and rehabilitation (weeks 2-6, F-100 at 150-220 mL/kg/day targeting 10-15 g/kg/day weight gain). Refeeding syndrome is prevented by the deliberately low-calorie F-75 in stabilisation. Community management of uncomplicated SAM uses RUTF after a passed appetite test. MAM is managed with RUTF or supplementary feeding at community level. Parent counselling covers cause (no-blame framing), home feeding, danger signs, and NRC-linked follow-up. India's NHM operates NRCs for inpatient SAM care; community CbM handles uncomplicated SAM post-discharge.

REFLECT

Consider the scenario: an 18-month-old with SAM is about to be discharged from the NRC after 14 days. His weight has improved from 6.5 kg to 7.8 kg, oedema has resolved, and he is eating well. However, his family lives 60 km from the NRC, and the mother says she cannot afford to return for follow-up. What would your counselling and discharge plan include to maximise the chance of sustained recovery? Reflect on how the hospital-community continuum of care — NRC, ASHA workers, Anganwadi centres, supplementary nutrition programme — can work together even when direct follow-up is not possible. This reflection exposes the real-world complexity of managing SAM beyond the protocol steps.