Consensus Statement of the Indian Academy of Pediatrics on Integrated Management of Severe Acute Malnutrition.
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Date
2013-04
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Abstract
Justification: Severe acute malnutrition (SAM) is a major public health issue. It afflicts an estimated 8.1 million under-five children in
India causing nearly 0.6 million deaths. The improved understanding of pathophysiology of SAM as well as new internationally
accepted growth charts and newer modalities of integrated intervention have necessitated a relook at IAP recommendations.
Process: A National Consultative Meeting on Integrated Management of Severe Acute Malnutrition was held in Mumbai on 16th and
17th October, 2010. It was attended by the invited experts in the field. Extensive discussions were held as per the program. The
participants were then divided into six groups for detailed discussions. The groups deliberated on various issues pertaining to the task
assigned and presented recommendations of the groups in a plenary session. The participants made a list of recommendations after
extensive discussions. A Writing Committee was formed and was entrusted with the task of drawing a Consensus Statement on the
basis of these Recommendations. After multiple deliberations, the following Consensus Statement was adopted.
Objectives: To critically evaluate the current global evidence to formulate a consensus among stakeholders regarding diagnosis and
management of SAM.
Recommendations: An integrated management of malnutrition is likely to yield more dividends. Thus, management of SAM should
constitute an important component of Integrated Management of Neonatal and Childhood Illnesses (IMNCI) program. Determination
of SAM on the basis of Z-scores using WHO Growth charts is considered statistically more appropriate than cut-offs based on
percentage weight deficit of the median. Considering the fact that many children with SAM can be successfully managed on outpatient
basis and even in the community, it is no more considered necessary to advise admission of all children with SAM to a healthcare
facility. Management of SAM should not be a stand-alone program. It should integrate with community management therapeutic
programs and linkages with child treatment center, district hospitals and tertiary level centers offering inpatient management for SAM
and include judicious use of ready-to-use-therapeutic Food (RUTF). All sections of healthcare providers need to be trained in the
integrated management of SAM.
Description
Keywords
Child, Malnutrition, Management, Ready-to-Use-Therapeutic Food
Citation
Dalwai Samir, Choudhury Panna, Bavdekar Sandeep B, Dalal Rupal, Kapil Umesh, Dubey A P, Ugra Deepak, Agnani Manohar Sachdev H P S. Consensus Statement of the Indian Academy of Pediatrics on Integrated Management of Severe Acute Malnutrition. Indian Pediatrics. 2013 April; 50(4): 399-404.