Intended for healthcare professionals

Rapid response to:

Clinical Review

Management of the severely malnourished child: perspective from developing countries

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7381.146 (Published 18 January 2003) Cite this as: BMJ 2003;326:146

Rapid Response:

Development of Guidelines for Effective Home Based Care and Treatment of Children Suffering from Acute Severe Under nutrition

In India, as per the National Family Health Survey-II , the
percentage of children with severe under nutrition by weight-for-age
– 3 SD is 18% , height-for-age – 3 SD is 23% and weight for height is
2.8%.

Inspite of a significant percentage of children suffering from
chronic under nutrition, acute malnutrition and acute chronic
malnutrition, presently is no specific guidelines are available on what
interventions should be provided at the home level by team of Anganwadi
workers and ANMs while utilizing the existing health and nutrition
services available at the village level.

According to WHO guidelines for management of children suffering from
severe under nutrition, weight for height -3 SD requires management in
hospitals after admission.

In India, 2.8% of children below 36 months of age were documented to
be suffering from acute variety of severe under nutrition i.e. weight-for
-height less than –3SD (NFHS-II, 1998-99). With the current total
population of India as 1100 million, it is expected presently 88 million
children (about 8% ) would be in under three years of age and out of this
2.6 million will be suffering from acute severe under nutrition.(weight-
for-height less than –3 SD).

A strong scientific evidence exists on synergism between under
nutrition and child mortality due to morbidities like diarrhea, acute
respiratory infections, malaria and measles. The risk of death is 20-60
times higher when severely undernourished child suffers from any of these
morbidities.

In India, presently no guidelines are available for management of
children suffering acute severe under nutrition (uncomplicated) weight for
height –3SD. The children suffering from acute severe under nutrition
(uncomplicated) usually reside in poor communities with poverty, low
sanitary conditions and possibly other factors which could adversely
affects the nutritional status of a child. There is a need to develop
practical and operational guidelines within the existing resource
constraints, which can be implemented for treatment of children with acute
severe under nutrition (uncomplicated) residing in villages/ urban slums.

Adequate scientific evidence is available on management of severely
malnourished children in the hospital situations utilising the WHO
guidelines. This approach reduces the mortality amongst the young
children. But limited scientific evidence exists on the management of
children with acute severe under nutrition (uncomplicated) at the family
level in the community.

A limited scientific evidence is available on the treatment of acute
severely malnourished (uncomplicated) children (- 3SD weight for height)
with Ready to Use Therapeutic Foods (RUTF) in the community settings.

The studies have documented that domiciliary management is most
popular with the parents and is most cost-effective as compared to
hospital admission and day care management.

What is needed is to development of Guidelines for Effective Home
Based Care and Treatment of Children Suffering from Acute Severe Under
nutrition so that the children who donot have any complication can be
managed at home.

Competing interests:
None declared

Competing interests: No competing interests

18 September 2005
Umesh Kapil
Professor, Public Health Nutrition
NIL;
All India Institute of Medical Sciences, new Delhi, India 110029