Management of acute malnutrition, surveys and indicators

Explanation : SAM is defined by a MUAC below 115 mm, a weight-for-height below -3 z (WHO standards) or bilateral pitting oedema. A MUAC from 115 to less than 125 mm and a weight-for-height between -3 and -2 z indicate MAM.

Explanation : Grade +++ oedema is on its own a criterion for inpatient care, even if the appetite test is passed. Grade + and ++ oedema without complications can be managed as outpatients.

Explanation : GAM = weight-for-height below -2 z and/or oedema: (49 + 3) / 612 = 8.5%. 8.0% leaves out oedema; 2.3% corresponds to SAM ((11 + 3) / 612).

Explanation : The thresholds are: below 2.5% very low, 2.5 to less than 5% low, 5 to less than 10% medium, 10 to less than 15% high, 15% and above very high.

Explanation : The IPC Acute Malnutrition scale uses: phase 1 below 5%, phase 2 from 5 to 9.9%, phase 3 from 10 to 14.9%, phase 4 from 15 to 29.9%, phase 5 at 30% and above.

Explanation : Default rate: 56 / 400 = 14%. Sphere sets for SAM: cured above 75%, deaths below 10%, defaulters below 15%. Here, cured at 78% and deaths at 2% are also compliant.

Explanation : Requirements: 7.5 x 200 = 1,500 kcal/day, i.e. 1,500 / 500 = 3 sachets per day, so 3 x 7 = 21 sachets per week.

Explanation : Children aged 6 to 59 months: 250,000 x 0.20 = 50,000. Prevalent cases: 50,000 x 0.02 = 1,000. Annual caseload: 1,000 x 2.6 = 2,600 cases. 1,000 cases ignores new cases arising during the year.

Explanation : Sphere sets coverage at more than 50% in rural areas, more than 70% in urban areas and more than 90% in camps.

Explanation : CMR = 54 / (15,000 x 90) x 10,000 = 54 / 1,350,000 x 10,000 = 0.40. The commonly used emergency threshold is 1 death per 10,000 people per day.

Explanation : WHO recommends using the same indicator for discharge as for admission; for MUAC, the discharge threshold is 125 mm, with no oedema for two weeks. 115 mm remains the SAM threshold.

Explanation : Failing the appetite test is in itself a sign of complication and warrants stabilisation in an inpatient setting.

Explanation : Routine oral antibiotics are recommended because infections are often silent. Iron is not given as a supplement on admission, as RUTF already contains it, and F-75 is reserved for the stabilisation phase in hospital.

Explanation : F-75, low in protein and sodium, is suited to the initial phase. F-100 or RUTF is introduced in the transition and then rehabilitation phases.

Explanation : The dose is 100,000 IU from 6 to 11 months and 200,000 IU from 12 to 59 months.

Explanation : Untargeted distributions of substitutes undermine breastfeeding and increase the risk of illness in poor hygiene conditions. The Operational Guidance on Infant and Young Child Feeding in Emergencies provides for targeted, supervised use.

Explanation : The standard measurement is taken on the left arm, hanging down, at the midpoint previously marked between the shoulder (acromion) and the elbow (olecranon).

Explanation : Gain: 700 g in 14 days, i.e. 50 g/day. Relative to the admission weight: 50 / 6.0 = 8.3 g/kg/day. 50 is the gain in grams per day, not per kilo.

Explanation : For MAM, Sphere sets a death rate below 3%; the threshold of below 10% applies to SAM, which has a higher case fatality.

Explanation : SAM includes MUAC below 115 mm and all bilateral oedema: (37 + 3) / 1,850 = 2.2%. 10.2% adds SAM and MAM together; 8.0% corresponds to MAM alone.