KZN Guidelines on Acute Malnutrition Management

KZN Guidelines on Integrated Management of Acute Malnutrition (IMAM)

• These guidelines provide a framework for managing acute malnutrition in KwaZulu-Natal
• They're based on WHO recommendations and the overall concept of CMAM (Community-Based Management of Acute Malnutrition)
• The guidelines aim to improve early detection and referral of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM) cases in children under 5.
• There's a focus on outpatient and inpatient management, and community-based frameworks for care.
• The guidelines offer specific treatment protocols for individual cases.
• They address both inpatient and outpatient management, and consider community participation and outreach to reach children early in the development of malnutrition.
• The guidelines include a monitoring and evaluation framework to ensure the policy is implemented correctly at all levels of care.
• The guidelines prioritize early detection and treatment of SAM, emphasizing community outreach in the process.
• They acknowledge the high poverty rates in KZN and the prevalence of concurrent epidemics like malnutrition, HIV/AIDS, and tuberculosis.
• The guidelines consider the cycle of poverty and disease, emphasizing the long-term effects of malnutrition on individuals and the economy.

Background

• Malnutrition, HIV, and TB are concurrent epidemics in South Africa, worsening existing poverty and increasing mortality rates in KZN.
• Food insecurity is linked to poor nutrition, affecting immunity and increasing disease susceptibility.
• Undernutrition has significant effects on physical and mental potential, reducing national and individual productivity and increasing costs to individuals and countries.

Assessment and Classification

• Acute malnutrition is characterized by bilateral pitting pedal edema or severe wasting, with associated signs like poor appetite.
• Types: SAM (severe acute malnutrition) and MAM (moderate acute malnutrition).
• Assessment includes defining nutritional status with MUAC measurements and weight/height ratios.
• Classification involves determining the grade of bilateral pitting oedema

Inpatient Management

• Stabilization phase focuses on restoring cellular function, controlling infections and addressing complications (low blood sugar, low temperature, poor feeding, diarrhoea).
• It often involves IV fluids and specific feeding protocols (F75).
• Rehabilitation phase focuses on rebuilding body stores and gaining weight.
• Closely monitoring pulse and respiratory rate is crucial.
• Feeding is cautiously increased and adapted to the child's needs, with appropriate follow up.
• Nutritional and medical interventions are administered and are adjusted throughout the treatment period.
• The child's health is frequently assessed for possible complications.

Outpatient Management

• Outpatient Supplementary Programme (OSP) is for children 6-59 Months.
• Includes specific dietary treatments and interventions based on age and weight to support growth .
• There's an emphasis on home-based care and supporting the mother.
• Follow-ups are crucial to monitor progress.
• The use of supplementary foods is common, and the need to maintain adequate feeding amounts is stressed.

Community Outreach

• Important for early detection and referral of cases with SAM.
• Key to the success of the service.
• Includes community participation for outreach.
• Outreach is linked with health facilities for referrals.
• The Operation Sukuma Sakhe (OSS) program plays a key role.

Monitoring and Evaluation

• Designed to track the implementation of guidelines by hospital and primary healthcare clinics.
• The implementation of these guidelines is reviewed in 2015 for additional information or changes.
• Includes the collection of data at all levels of care before submitting to the DHIS (District Health Information System).
• Key indicators include inpatient and outpatient case management statistics (e.g., admissions, deaths, recovery rates).
• Monitoring is performed to ensure there are resources available at hospitals and community level clinics.

Other important aspects

• Guidelines involve various partnerships between different health service providers
• The guidelines are specific for SAM but also mention MAM which is an important consideration.
• The guidelines emphasize the close involvement of the caregiver in the care of the child.
• The overall objective is to strengthen and improve preventive and promotive care, with a focus on awareness and addressing community needs in relation to nutritional interventions.

This quiz explores the KZN Guidelines for the Integrated Management of Acute Malnutrition (IMAM). Based on WHO recommendations, the guidelines emphasize early detection and community-based care for children under 5 with acute malnutrition. Test your knowledge on the protocols and frameworks set forth for effective management.