Current WHO guidelines recommend oral amoxicillin for children with uncomplicated malnutrition and parenteral benzylpenicillin and gentamicin for those with complicated malnutrition. Because of cost pressures and increasing antimicrobial resistance, the administration of empirical antibiotics for children with SAM has recently been debated.
Full Answer
What recommendations have been made for the treatment of Sam?
Recommendations are made regarding the following: Admission and discharge criteria for children who are 6–59 months of age with SAM Where to manage children with SAM who have oedema Use of antibiotics in the management of children with SAM in outpatient care Vitamin A supplementation in the treatment of children with SAM
What is the cure rate of Sam protocol?
The cure rate of the man- agement of SAM protocol in such a group is close to 100 per cent. Late treatment seeking and weak case finding and admission will result in a group of more severe and more complicat- ed cases. The cure rate in such a cohort may be much lower than 100 per cent.
Why do we need National Sam guidelines?
Developing or updating national guidelines is a necessary step in building consensus and buy- in for the approach to management of SAM, adapting the approach to the country context and reflecting management of SAM in policy.
How can we improve the management of Sam?
This recognition has led to a shift in implementation focus and efforts to embed the management of SAM in national health systems and community structures. Thus, the management of SAM needs to be scaled up through deliberate efforts to increase programme coverage for treatment of children.
What is the treatment for Sam?
F75 and F100 are specially formulated milks used in inpatient settings to treat SAM. F75 is given in the stabilization phase of inpatient treatment; children are provided with approximately 80–100 kilocalories per kilogram per day (kcal/kg/d) spread over 8–12 meals per day for three to seven days.
What are criteria for Sam?
Severe Acute Malnutrition (SAM) Severe acute malnutrition is defined by very low weight-for-height/length (Z- score below -3 SD of the median WHO child growth standards), or a mid-upper arm circumference < 115 mm, or by the presence of nutritional oedema. Severe Acute Malnutrition is both a medical and social disorder.
What is the difference between MAM and SAM?
MAM is defined as MUAC < 12.5 cm, but ≥ 11.5 cm. Non-complicated SAM will be defined as MUAC < 11.5 cm, or + or ++ bilateral edema, and having an acceptable appetite. An acceptable appetite will be judged by giving the child 30 g of RUTF and asking the mother to feed this food to the child over 20 minutes.
What are the management of the child Sam with dehydration?
Children with severe acute malnutrition who present with some dehydration or severe dehydration but who are not shocked should be rehydrated slowly, either orally or by nasogastric tube, using oral rehydration solution ORS (5–10 mL/kg/h up to a maximum of 12 h).
WHO discharge criteria for Sam?
Since 2013 the World Health Organization (WHO) has recommended that children with SAM should only be discharged from treatment when their WHZ or weight-for-length z-score (WLZ) is ≥ –2 or mid-upper arm circumference is ≥125 mm (MUAC ≥125mm) and they have had no oedema for at least two weeks.
How is Sam and MAM calculated?
How do we estimate case load for SAM and / or MAM in children 6 – 59 months in a given time period? A common approach to this problem is to use the formula: case load = N × P × K × C where: N is the size of the population in the program area.
What is the meaning of Sam in ICDS?
with Severe Acute MalnutritionManagement of Children with Severe Acute Malnutrition (SAM)
What is Sam in PSM?
• SAM = Severe Acute Malnutrition.
What is full form of Sam?
The Full form of SAM is Severe Acute Malnutrition. Its face is a child – frail and skeletal – who requires urgent treatment to survive. Children with SAM (Severe Acute Malnutrition) have very low weight for their height and severe muscle wasting.
WHO recommended Oral Rehydration Solution?
For more than 25 years, WHO and UNICEF have recommended a single formulation of glucose-based oral rehydration salts to prevent or treat dehydration from diarrhoea irrespective of the cause or age group affected.
What is the difference between f75 and f100?
F-75 contains 75 kcal and 0.9 g protein per 100 ml. As soon as the child is stabilized on F-75, F-100 is used as a "catch-up" formula to rebuild wasted tissues. F-100 contains more calories and protein: 100 kcal and 2.9g protein per 100 ml.
How is severe acute malnutrition treated in dehydration?
Children with severe acute malnutrition who present with some dehydration or severe dehydration but who are not shocked should be rehydrated slowly, either orally or by nasogastric tube, using oral rehydration solution ORS (5–10 mL/kg/h up to a maximum of 12 h).
Do children with SAM have fever?
For example, because of the changes in metabolic and physiological responses, children with SAM often do not present the typical clinical signs of infection (such as fever) that well-nourished children show when they are ill. In fact, infection very often presents with hypothermia.
Does SAM cause anemia?
Nearly all children with SAM have anaemia, which is often associated with bacteraemia, frequent bouts of malaria, hookworm infection, HIV infection and micronutrient deficiencies. But studies show that the children have increased body stores of iron – iron deficiency is rare in SAM children.
Is paracetamol nephrotoxic?
o Paracetamol ( do not use in acute phase – hepati c damage) o Amphoteracin B(do not use in acute phase – nephrotoxic to some extent in ALL patients, also commonly causes hypokalaemia, hypomagnesaemia, diarrhoea, anaemia, severe anorexia and, uncommonly, anaphylaxis).
Why is F75 used in the transition phase?
The formula used during this phase (F75) promotes recovery of normal metabolic function and nutrition-electrolytic balance. Rapid weight gain at this stage is dangerous, that is why F75 is formulated so that patients do not gain weight during this stage. -Transition Phase.
What is the RDA for a child with severe malnutrition?
The RDA (USA) for such a child is 1700 IU (0.5mg) per day. 11“Discharge” means discharge from care for severe malnutrition – this is for those children who have completed Phase 2 as an in-patient. It does not mean transfer from an in-patient to out-patient facility to continue treatment.
What is the first phase of SAM?
Treatment of complicated SAM is divided into phases. The first phase—or the stabilization phase—involves the use of a milk-based formula called F-75 (low protein, low energy feed). There is generally a transition phase before patients move to the rehabilitation phase, during which another milk-based formula, F-100 (high protein, high energy feed), ...
Why are RUTFs used in children?
The author explains that because RUTFs are used in the treatment of children with Severe Acute Malnutrition (SAM) without medical complications, a guideline could help ensure products are safe, efficacious and of good quality.
Is Rutf water based?
The feed is not water-based, which means the risk of bacterial growth is very limited. This makes RUTF safe to use where hygiene conditions are not optimal and without refrigeration at household level. 16,17. It does not spoil easily, even after opening. 18. It is provided in the format “ready-to-use.”.
Can children consume Rutf?
Children can consume RUTF with minimal supervision at home, often directly from the package, at any time of the day or night. 12,13. RUTF offers the possibility of the rehabilitation phase of treatment to be completed at home for several reasons: 14.
Should RUTF be regulated?
It has been suggested that RUTF should be regulated by an independent body, not directly involved with the purchasing and use of the products. Such a guideline would provide a reassuring framework, facilitating endorsement of new producers/products and ensuring consumer protection.
How many children in the world received SAM treatment in 2013?
Despite significant progress in recent years, approximately 2.9 million children accessed treatment in 65 countries in 2013 – only about 17 percent of the children needing treatment. Children with SAM are nine times more likely to die than well-nourished children.
What is SAM in nutrition?
The management of severe acute malnutrition (SAM) is critical for child survival and is a key cost-effective component of the scaling up nutrition framework for addressing undernutrition. Governments face great challenges in building capacity and providing sufficient resources to prevent and treat acute malnutrition.
