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

Geneva: World Health Organization; 1999, 60 pp.
ISBN 92 4 154511 9



Malnutrition is still one of the most common causes of morbidity and mortality among children worldwide. Successfully managing the severe malnutrition of children requires a recognition not only of medical problems but also of social ones that can increase the likelihood of relapse when children return home.

This new manual from the World Health Organization presents practical guidelines to treat severely malnourished children under five years of age. The primary focus is on caring for children in a hospital or health center, but the text also briefly covers disaster situations, refugee camps, and malnutrition in adolescents and adults. The guide is intended for health personnel working at the central and regional level of a country, including physicians, nurses, midwives, and aides and other auxiliaries.

The manual divides malnutrition care into three phases: initial treatment, when the problems are identified and feeding is begun; rehabilitation, when intensive feeding is given to recover most of the lost weight and the mother or other caregiver is trained to continue treatment at home; and follow-up, to prevent relapse and assure the child’s continued development.

After comparing the advantages and disadvantages of residential and nonresidential treatment, the text describes the evaluation of a malnourished child. The next chapter, on initial treatment, includes sections on hypoglycemia, hypothermia, dehydration, dietary treatment, infections, and vitamin deficiencies.

A chapter on rehabilitation covers both nutrition and emotional and physical stimulation and teaching parents how to prevent malnutrition from recurring. In a chapter on follow-up, the manual suggests specific intervals for health-worker visits to a child at home and standards for judging whether adequate progress is being made.

A chapter on failure to respond to treatment describes general problems that may occur in a treatment facility, as well as the complications that individual children may face, such as feeding difficulties, infections, and serious underlying disease.

Two shorter chapters cover managing malnutrition in disaster situations and refugee camps and treating adolescents and adults.

The book has eight appendices, with such useful resources as reference values for weight-for-height and weight-for-length, sample recording forms and charts, and the composition of mineral and vitamin mixes. Two of the appendices even provide information on inexpensive, simple-to-make toys for children and a sample curriculum for using the toys for children’s language and motor development.

This text is notable for its clear language, logical organization and progression of materials, and balanced combination of general principles and specific steps for the various phases of treating severe malnutrition. The new manual will provide health care professionals, and, in turn, the parents of malnourished children, the knowledge they need to help treat this condition and ensure that it does not recur.

Organización Panamericana de la Salud Washington - Washington - United States