training course on the management of severe acute malnutrition participant module

299 Pages·2013·5.59 MB·English

TRAINING COURSE ON THE
MANAGEMENT OF SEVERE ACUTE
MALNUTRITION

PARTICIPANT MODULE

Federal democratic Republic of
Ethiopia, Ministry of Health

Second Edition, 2013
Addis Ababa, Ethiopia
CONTACT ADDRESS

Federal Democratic Republic of ETHIOPIA
Ministry of Health

P.O.Box: 1234
Addis Ababa, ETHIOPIA

Tel: (+251) (11) 515 99 78; 515 0407
Fax: (+251) (11) 552 45 49

E-mail: [email protected]
Web site: www.moh.gove.et
TRAINING COURSE ON THE
MANAGEMENT OF SEVERE ACUTE
MALNUTRITION

PARTICIPANT MODULE

Federal Democratic Republic of
ETHIOPIA Ministry of Health

Second Edition, 2013
Addis Ababa, Ethiopia
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Acknowledgement (First Edition)
The first National Protocol on the Management of Severe Acute Malnutrition (SAM) was
developed in 2004 and the 2nd and updated version was made available as of March 2007.
However, there was no standardized and comprehensive training course material on the
management of SAM using adult learning methodology and which encompasses adequate clinical
practice sessions.

Thus, this package of standardized modular training course material was developed using the
WHO “Training Course on the Management of SAM, 2002” as template but taking most of the
contents from the “National Protocol for the Management of SAM, 2007”. The package consists
of two sets of training materials: a set of modules for a 6 days’ integrated course material
(Training Course on the Management of SAM, 2011) which combines both the inpatient and
outpatient care, and a separate set of modules for a 2 days’ course on the outpatient care (Training
Course on the Outpatient Treatment Program of SAM, 2011).

The first edition of this training material was developed and printed through the technical and
financial assistance of WHO/Ethiopia and with the support and valuable input of key partners
especially UNICEF, Concern/Ethiopia, Save the Children USA and many experts in the field. It
is our strong belief that this training package will contribute significantly to the efforts being
made to improve the quality of care provided for malnourished children both at outpatient and
inpatient care services.
In this regard, the FMOH would like to appreciate the effort of WHO country office to coordinate
and lead this task and the support of UNICEF, Concern, Save the Children USA and the Medical
faculty of Addis Ababa University for their valuable contribution in the development of this
training material.
We would like to sincerely acknowledge the remarkable contribution of Dr Damte Shimelis
(Pediatrician, Addis Ababa University, Medical Faculty) and Dr Habtamu Fekadu (Pediatrician
& Nutritionist) who served as consultants in the adaptation of the generic WHO modules.

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The FMOH gratefully acknowledge the contribution of all who participated in this work
especially the following professionals for their technical input in the development of this national
training course material on the management of SAM.
Dr Belaynesh Yifru - Nutrition/FMOH
Dr Sirak Hailu - WHO/Ethiopia
Dr Solomon Emyu - WHO/Ethiopia
Dr Tewoldeberhan Daniel - UNICEF/Ethiopia
Mr. Samson Dessie - UNICEF/Ethiopia
Ms. Sylvie Chamois - UNICEF/Ethiopia
Dr Tedbabe Degefie - UNICEF/Ethiopia
Dr H/mariam Legesse - UNICEF/Ethiopia
Dr Hailu Tesfaye - Save the Children/USA
Mrs Emily Mates - Concern/Ethiopia
Ms Abinet Shiferaw - Concern/Ethiopia
Dr Mengistu Tafesse - Pediatrician and Private consultant
Dr Abdulaziz Ali - FANTA Project/FMOH

Special thanks go to Mrs Genet Kassa of WHO/Ethiopia for her assistance in formatting of the
final material.

Finally, the Ministry of Health would like to recognize all the program managers and technical
staff in the FMOH who contributed to the finalization of the document.

Neghist Tesfaye Belayneh (MD, MSc IH)
Director, Urban Health Promotion and Disease Prevention Directorate
Federal Ministry of Health
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Acknowledgement (Second Edition)

The FMOH gratefully acknowledge the contribution of all who participated in the revision and
preparation of the second edition of these training materials, especially the following
professionals for their technical input in the development of this national training course material
on the management of SAM.
Dr Sirak Hailu - WHO/Ethiopia
Dr Solomon Emyu - WHO/Ethiopia
Mr Getahun Teka - WHO/Ethiopia
Dr Tewoldeberhan Daniel - UNICEF/Ethiopia
Dr Hailu Tesfaye - Save the Children
Dr Abdulaziz Ali - Save the Children
Mrs Rita Nemero - Save the Children
Dr Habtamu Fekadu - Save the Children
Dr Damte Shimelis - AAU
Mr Mesfin Gose - FMOH
Dr Menbeu - Adama Hospital

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MODULE CONTENT

Acknowledgement (First Edition) .................................................................................. i
Acknowledgement (Second Edition) ........................................................................... iii
SESSION 1: INTRODUCTION ................................................................................... 1
1.1. Importance of severe malnutrition as a health problem ................................ 2
1.2. Overview of the Management of Acute Malnutrition ................................... 2
1.3. Purpose of this training course ...................................................................... 3
1.4. Course methods and materials ...................................................................... 3
1.5. Learning objectives of the module ............................................................... 4
1.6. Objectives for clinical practice sessions ........................................................ 5
SESSION 2: PRINCIPLE OF CARE ............................................................................ 7
1.0 Recognize signs of severe acute malnutrition ............................................... 9
2.0 Weigh and measure the child ...................................................................... 14
3.0 Identifying a child with severe acute malnutrition ...................................... 19
4.0 How does the physiology of severe malnutrition affect care of the child? . 29
5.0 Overview of the essential components of care ............................................ 32
6.0 Discharge Criteria ....................................................................................... 38
SESSION 3: MANAGEMENT OF MEDICAL COMPLICATIONS ........................ 39
1.0 Manage Hypoglycemia ............................................................................... 41
2.0 Manage Hypothermia .................................................................................. 43
3.0 Manage watery diarrhea and/or vomiting and Dehydration ........................ 50
4.0 Manage a severely malnourished child with shock ..................................... 57
5.0 Manage Severe Anemia .............................................................................. 59
6.0 Give emergency eye care for corneal clouding and ulceration ................... 65
7.0 Managing Heart failure .............................................................................. 66
8.0 Treat Infections ........................................................................................... 72
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SESSION 4: FEEDING .............................................................................................. 79
1.0 Prepare F-75 and F-100 ............................................................................... 81
2.0 Phase I Feeding ........................................................................................... 84
3.0 Transition Phase (Feeding the child in transition) ...................................... 97
4.0 Phase 2 (Feed freely with F-100 or RUTF) ............................................... 101
III. Management of SAM in HIV infected children .............................................. 111
6.0. Plan feeding for the ward ......................................................................... 113
SESSION 5: DAILY CARE ..................................................................................... 120
1.0 Handle the child gently ............................................................................. 122
2.0 Give Routine medicines and other medications ........................................ 128
3.0 Care for skin and bathe the child ............................................................... 131
4.0 Care for the eyes ........................................................................................ 132
5.0 Monitor pulse, respirations, and temperature, and watch for danger signs140
6.0 Provide continuing care at night ................................................................ 142
7.0 Weigh the child daily and maintain weight chart ...................................... 152
8.0. Discharge Criteria ..................................................................................... 156
SESSION 6: MONITORING AND PROBLEM SOLVING .................................... 157
1.0 Use a process to identify and solve problems ........................................... 159
2.0 Monitor and solve problems with an individual patient ............................ 164
3.0 Monitor overall weight gain in the inpatient Care/ward ........................... 181
4.0 Monitor patient outcomes .......................................................................... 188
5.0 Monitor practices and procedures ............................................................. 205
6.0. Solve problems .......................................................................................... 208
SESSION 7: OUT-PATIENT TREATMENT PROGRAM (OTP) ......................... 210
1.0. Recommended criteria for admission to OTP ........................................... 212
2.0. Outpatient Care for the management of SAM .......................................... 216
2.1. OTP Admission Procedure ............................................................................. 216
2.2. Management of SAM in OTP ........................................................................ 220
2.3. Follow-up ....................................................................................................... 228
2.4. Discharge criteria ........................................................................................... 231
2.5. Organization of OTP ...................................................................................... 236
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SESSION 8: MONITORING AND REPORTING OF TFP ..................................... 237
1.0. Monitor Performance of TFP .................................................................... 239
1.1 Calculate Performance Indicators ............................................................... 239
1.2. Minimum Standards for the performance Indictors ................................... 241
2.0. Recording and Reporting ............................................................................... 242
2.1. Assign Unique Registration Number ......................................................... 242
2.2. Recording in the individual follow-up cards .............................................. 242
2.3. Recording in TFP Registration book .......................................................... 242
2.4. Prepare monthly TFP statistic report .......................................................... 243
SESSION 9: INVOLVING MOTHERS IN CARE .................................................. 253
1.0 Organize facility routine to encourage mothers’ involvement .................. 255
2.0 Involve mothers in comforting, feeding, and bathing children ................. 257
3.0 Teach mothers about feeding and care ...................................................... 259
4.0 Teach mothers the importance of stimulation ........................................... 265
5.0 Give general discharge instructions .......................................................... 266
ANSWERS TO SHORT ANSWER EXERCISE ..................................................... 267
ANNEXES ................................................................................................................ 272
Annex A: Equipment and supplies needed for a severe malnutrition care ........... 273
Annex B: Therapeutic Treatment Multi-Chart ...................................................... 276
Annex C: Tips for correct preparation F-75 and F-100 ........................................ 280
Annex D: Monitoring Checklist ............................................................................ 282
Annex E : Calculating Estimated RUTF Needs .................................................... 286
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