Management of Severe Malnutrition
A Manual for Physicians and Other Senior Health Workers
Nonserial Publication
World Health Organization
ISBN-13    9789241545112 ISBN-10    9241545119
Order Number    11500465   
Price    CHF    26.00 / US$    31.20 Developing countries:    CHF    26.00
English     1999        67   pages
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Table of contents
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Summary
This manual provides expert practical guidelines for the management of severely malnourished children. Addressed to doctors and other senior health workers, the manual explains exactly what must be done to save lives, achieve successful management and rehabilitation, prevent relapse, and thus give these children the greatest chance of full recovery. Throughout, the importance of treating severe malnutrition as both a medical and a social disorder is repeatedly emphasized. As successful management does not require sophisticated facilities and equipment or highly qualified personnel, the manual also performs a persuasive function, encouraging health professionals to do all they can to save these children and meet their great need for care and affection.
Recommended procedures draw on extensive practical experience as well as several recent therapeutic advances. These include improved solutions of oral rehydration salts for the treatment of dehydration, better understanding of the role of micronutrients in dietary management, and growing evidence that physical and psychological stimulation can help prevent long-term consequences of impaired growth and psychological development. Noting that the physiology of malnourished children is seriously abnormal, the manual gives particular attention to aspects of management - whether involving the interpretation of symptoms or the use of specific interventions - that differ considerably from standard procedures for well-nourished children. Details range from the reasons why IV infusion easily causes overhydration and heart failure, through a list of treatments that have no value and should never be used, to the simple reminder that underarm temperature is not a reliable guide to body temperature in a malnourished child during rewarming.
Further practical guidance is provided in eight appendices, which use numerous tables, charts, sample recording forms, instructions for preparing feeds, and examples of easily constructed toys to help ensure that management is thorough, safe, and in line with the latest knowledge.

Contents
Treatment facilities
Evaluation of the malnourished child
- Assessment of nutritional status and criteria for admission
- History and physical examination
- Laboratory tests
Initial treatment
- Principles of management
- Hypoglycaemia
- Hypothermia
- Dehydration and septic shock
- Dietary treatment
- Infections
- Vitamin deficiencies
- Very severe anaemia
- Congestive heart failure
- Dermatosis of kwashiorkor
Rehabilitation
- Principles of management
- Nutritional rehabilitation
- Emotional and physical stimulation
- Teaching parents how to prevent malnutrition from recurring
- Preparation for discharge
Follow-up
Failure to respond to treatment
- General principles
- Problems with the treatment facility
- Problems with individual children
- Learning from failure
Management of malnutrition in disaster situations and refugee camps
- General considerations
- Establishing a therapeutic feeding centre
- Criteria for enrolment and discharge
- Principles of management
- Evaluation of the therapeutic feeding centre
Malnutrition in adolescents and adults
- Principles of management
- Classification of malnutrition
- History and physical examination
- Initial treatment
- Rehabilitation
- Criteria for discharge
- Failure to respond to treatment.