Nutrition

Severe acute malnutrition in Asia

Tahmeed Ahmed, Muttaquina Hossain, Mustafa Mahfuz, Nuzhat Choudhury and other team members

 

Asia is home to the largest number of children under 5 years of age with severe acute malnutrition (SAM), which is a major impediment to optimal human capital development, The World Health Organization (WHO)/UNICEF diagnostic criteria for SAM in children 6 to 59 months old include any of the following: weight-for-height z-score < -3 SD of WHO child growth standards, presence of bilateral pedal edema, and mid-upper-arm circumference (MUAC) <115 mm. Nearly 20 million children globally suffer from SAM, which is one of the top three nutrition-related causes of death in under-five children.
A child with SAM is 10 times more likely to die than a well-nourished child. Estimates of the number of deaths directly attributable to SAM vary from 0.5 to 2 million annually, Even up to the end of the 20th century, the case fatality rate for SAM among under-five children ranged from 20% to 50% in many centers.
The vast majority of children suffering from SAM are located in Africa and Asia.
India alone is home to more than 8 million children with SAM, while Africa has 5.6 million children with SAM.
In facility-based treatment of SAM, the initial stabilization phase focuses on restoring homeostasis and treating medical complications and usually takes 2 to 7 days of inpatient treatment; the rehabilitation phase focuses on rebuilding wasted tissues and may take several weeks , Although facility-based treatment is available in most countries, it is expensive, is inconvenient to the family as it requires prolonged hospitalization, and has limited outreach.
Community-based management of SAM can complement facility-based treatment by expanding outreach, limiting facility expenses, and allowing treatment at home, thereby decreasing the burden on families.
When community-based management is properly combined with a facility-based approach, the result is a reduction in mortality down to around 5%, This article is based on a review of SAM burden and intervention programs in Asian countries, where, despite the huge numbers of children suffering from the condition, the coverage of interventions is poor.
Bangladesh
Bangladesh has the sixth-highest number of children suffering from SAM in Asia.
The country has formulated national guidelines for the treatment of severely malnourished children, which, however, are yet to be implemented throughout the country.
When these guidelines are followed, treatment of children with complicated SAM can be effective in up to 88% of cases, even with minimum incremental expenditure. Home care of children with SAM has been shown to be 1.6 times and 4 times more cost effective than day care and inpatient care, respectively.
Clinical scientists at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr.b) have implemented a treatment protocol for children with SAM and diarrhea that resulted in a 50% reduction in the case fatality rate.
This treatment protocol, published prior to the WHO guidelines but based on similar principles of care, is now being implemented successfully for facility- based management of SAM in Bangladesh and in many other places.
In addition, Bangladeshi scientists have developed a standardized diet protocol for rapid catchup growth during nutritional rehabilitation using low- cost, culturally appropriate, nutritious food (khichuri and halwa) based on locally available ingredients enriched with essential micronutrients for growth and development.
In the southern region of Bangladesh, a pilot CMAM program initiated by an NGO has shown a high recovery rate (92%), even at the upazila (subdistrict) level.
The Sixth Five Year Plan of the government emphasizes SAM as an important deterrent of child health, while the operational plan of the newly established National Nutrition Services (NNS)
includes SAM as an action item. Despite all these positive steps, there is no national program to take care of the more than half-million children living with SAM and the close to 2 million children with MAM. A few pilot activities using imported RUTF have shown promising results; however, cost and sustainability are major constraints.
RUTFs based on locally available food ingredients have recently been developed and produced in the country by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr.b). The national guidelines and the training modules for CMAM have been developed by the government. In the national CMAM guidelines, the term “nutritional treatment” has been used in place of “ready-to-use therapeutic food” (RUTF).
The Government of Bangladesh has replaced the vertically managed National Nutrition Program with the NNS in an effort to mainstream nutrition as part of the Health, Population and Nutrition Sector Development Program (2011-16).
Implementation of direct or nutrition-specific interventions will be guided by the NNS Operational Plan.
The provision of community-based nutrition services will be scaled up, and the food and nutrition policies and plans will be implemented.
The recommended interventions for implementation include promotion of exclusive breastfeeding for 6 months and
continued breastfeeding up to 2 years; introduction of complementary foods of adequate nutritional quality and quantity after the age of 6 months; and improved hygiene practices, including
hand washing, micronutrient
supplementation, salt iodization,
growth-monitoring and promotion, and management of SAM.

 

 

Nutrition

Severe acute malnutrition in Asia Tahmeed Ahmed, Muttaquina Hossain, Mustafa Mahfuz, Nuzhat Choudhury and other team members Asia is home to the largest number of children under 5 years of age with severe acute malnutrition (SAM), which is a major impediment to optimal human capital development, The World Health Organization (WHO)/UNICEF diagnostic criteria for SAM in children 6 to 59 months old include any of the following: weight-for-height z-score -3 SD of WHO child growth standards, presence of bilateral pedal edema, and mid-upper-arm circumference (MUAC) 115 mm. Nearly 20 million children globally suffer from SAM, which is one of the top three nutrition-related causes of death in under-five children. A child with SAM is 10 times more likely to die than a well-nourished child. Estimates of the number of deaths directly attributable to SAM vary from 0.5 to 2 million annually, Even up to the end of the 20th century, the case fatality rate for SAM among under-five children ranged from 20% to 50% in many centers. The vast majority of children suffering from SAM are located in Africa and Asia. India alone is home to more than 8 million children with SAM, while Africa has 5.6 million children with SAM. In facility-based treatment of SAM, the initial stabilization phase focuses on restoring homeostasis and treating medical complications and usually takes 2 to 7 days of inpatient treatment; the rehabilitation phase focuses on rebuilding wasted tissues and may take several weeks , Although facility-based treatment is available in most countries, it is expensive, is inconvenient to the family as it requires prolonged hospitalization, and has limited outreach. Community-based management of SAM can complement facility-based treatment by expanding outreach, limiting facility expenses, and allowing treatment at home, thereby decreasing the burden on families. When community-based management is properly combined with a facility-based approach, the result is a reduction in mortality down to around 5%, This article is based on a review of SAM burden and intervention programs in Asian countries, where, despite the huge numbers of children suffering from the condition, the coverage of interventions is poor. Bangladesh Bangladesh has the sixth-highest number of children suffering from SAM in Asia. The country has formulated national guidelines for the treatment of severely malnourished children, which, however, are yet to be implemented throughout the country. When these guidelines are followed, treatment of children with complicated SAM can be effective in up to 88% of cases, even with minimum incremental expenditure. Home care of children with SAM has been shown to be 1.6 times and 4 times more cost effective than day care and inpatient care, respectively. Clinical scientists at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr.b) have implemented a treatment protocol for children with SAM and diarrhea that resulted in a 50% reduction in the case fatality rate. This treatment protocol, published prior to the WHO guidelines but based on similar principles of care, is now being implemented successfully for facility- based management of SAM in Bangladesh and in many other places. In addition, Bangladeshi scientists have developed a standardized diet protocol for rapid catchup growth during nutritional rehabilitation using low- cost, culturally appropriate, nutritious food (khichuri and halwa) based on locally available ingredients enriched with essential micronutrients for growth and development. In the southern region of Bangladesh, a pilot CMAM program initiated by an NGO has shown a high recovery rate (92%), even at the upazila (subdistrict) level. The Sixth Five Year Plan of the government emphasizes SAM as an important deterrent of child health, while the operational plan of the newly established National Nutrition Services (NNS) includes SAM as an action item. Despite all these positive steps, there is no national program to take care of the more than half-million children living with SAM and the close to 2 million children with MAM. A few pilot activities using imported RUTF have shown promising results; however, cost and sustainability are major constraints. RUTFs based on locally available food ingredients have recently been developed and produced in the country by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr.b). The national guidelines and the training modules for CMAM have been developed by the government. In the national CMAM guidelines, the term nutritional treatment has been used in place of ready-to-use therapeutic food (RUTF). The Government of Bangladesh has replaced the vertically managed National Nutrition Program with the NNS in an effort to mainstream nutrition as part of the Health, Population and Nutrition Sector Development Program (2011-16). Implementation of direct or nutrition-specific interventions will be guided by the NNS Operational Plan. The provision of community-based nutrition services will be scaled up, and the food and nutrition policies and plans will be implemented. The recommended interventions for implementation include promotion of exclusive breastfeeding for 6 months and continued breastfeeding up to 2 years; introduction of complementary foods of adequate nutritional quality and quantity after the age of 6 months; and improved hygiene practices, including hand washing, micronutrient supplementation, salt iodization, growth-monitoring and promotion, and management of SAM.