Management of severe malnutrition: a manual for physicians and other senior health workers

Contents

Preface
Acknowledgements
1. Introduction
2. Treatment facilities
3. Evaluation of the malnourished child
3.1 Assessment of nutritional status and criteria for admission
3.2 History and physical examination
3.3 Laboratory tests
4. Initial treatment
4.1 Principles of management
4.2 Hypoglycaemia
4.3 Hypothermia
4.4 Dehydration and septic shock
Diagnosis
Treatment of dehydration
Treatment of septic shock
4.5 Dietary treatment
Formula diets for severely malnourished children
Feeding on admission
Nasogastric feeding
Feeding after the appetite improves
Milk intolerance
Recording food intake
4.6 Infections
Bacterial infections
Measles and other viral infections
4.7 Vitamin deficiencies
Vitamin A deficiency
Other vitamin deficiencies
4.8 Very severe anaemia
4.9 Congestive heart failure
4.10 Dermatosis of kwashiorkor
5. Rehabilitation
5.1 Principles of management
5.2 Nutritional rehabilitation
Feeding children under 24 months
Feeding children over 24 months
Folic acid and iron
Assessing progress
5.3 Emotional and physical stimulation
The environment
Play activities
Physical activities

Management of severe malnutrition: a manual for physicians and other senior health workers
5.4 Teaching parents how to prevent malnutrition from recurring
5.5 Preparation for discharge
Criteria for discharge
Appropriate diets
Immunization
Planning follow-up
6. Follow-up
7. Failure to respond to treatment
7.1 General principles
7.2 Problems with the treatment facility
Type of facility
Staff
Inaccurate weighing machines
Problems with preparing or giving food
7.3 Problems with individual children
Feeding
Infection
Serious underlying disease
7.4 Learning from failure
8. Management of malnutrition in disaster situations and refugee camps
8.1 General considerations
8.2 Establishing a therapeutic feeding centre
Location and capacity
Water supply and sanitation
Cooking facilities and supplies
Staff
8.3 Criteria for enrolment and discharge
8.4 Principles of management
8.5 Evaluation of the therapeutic feeding centre
9. Malnutrition in adolescents and adults
9.1 Principles of management
9.2 Classification of malnutrition
Adults (over 18 years)
Adolescents (10–18 years)
9.3 History and physical examination
9.4 Initial treatment
9.5 Rehabilitation
9.6 Criteria for discharge
9.7 Failure to respond to treatment
References
Appendices
1. NCHS/WHO normalized reference values for weight-for-height and
weight-for-length
2. Sample recording form
3. Physiological basis for treatment of severe malnutrition
4. Composition of mineral and vitamin mixes
5. Desirable daily nutrient intake during initial phase of treatment
6. Drug dosages for treatment of infections
7. Toys for severely malnourished children
8. Sample curriculum for play therapy