Saving children from severe acute malnutrition

According to the World Health Organization (WHO), severe acute malnutrition is a life-threatening condition that requires urgent treatment. Up until recent times, the recommendation was to refer these children to the hospital to receive therapeutic diets along with medical care. The situation changed with the advent of ready-to-use therapeutic foods (RUTF), which sees the management of a large number of severely malnourished children above the age of six months through outpatient settings.

WHO states that although the median under-five case-fatality rate for severe acute malnutrition typically ranges from 30 per cent to 50 per cent, it can be reduced substantially when physiological and metabolic changes are taken into account. Management of severe acute malnutrition according to WHO guidelines can reduce the case-fatality rate by about 55 per cent in hospital settings.

Private Kamanzi, a dietician at Amazon Wellness Centre, Remera, Gasabo District, says that severe acute malnutrition is common among children under five years, these children have low weight for their age, and severe muscle wasting.

According to The United Nations Children’s Fund (UNICEF), children with severe acute malnutrition may also have nutritional oedema — characterised by swollen feet, face and limbs. Severe acute malnutrition is a major cause of death in children under five years, and its prevention and treatment are critical to child survival and development.

UNICEF also states, across the globe, an estimated 16 million children under the age of five are affected by severe acute malnutrition. This number is staggering — most importantly, because children with severe acute malnutrition are nine times more likely to die than well-nourished children. These deaths are the direct result of malnutrition itself, as well as the indirect result of childhood illnesses like diarrhoea and pneumonia, that malnourished children are too weak to survive.

Kamanzi explains that if the child is not treated or given intensive care immediately, they can even lose their lives. 

“Severe acute malnutrition causes congestive heart failure - CHF (a chronic progressive condition that affects the pumping power of the heart muscles). The main cause of severe acute malnutrition is only two. That is, inadequate food intake, and poor care of a child,” Kamanzi says. 

He further says, severe acute malnutrition starts when it is moderate, however, if the child is not given proper nutrition and care as soon as possible, the illness becomes severe.

Kamanzi explains that severe acute malnutrition also affects the brain development of a child, and the motor development, this involves learning skills, and cognitive language, that is why some people can’t express themselves in public.

If the child is sick, there are high chances of having acute malnutrition because in most cases they will lose appetite, and their dietary needs increase, which causes moderate acute malnutrition, he says.

“The underlying cause of the condition could also be due to lack of knowledge about complementary feeding (complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore, other foods and liquids are needed, along with breast milk),” he says.

Kamanzi also points out that poor knowledge about breastfeeding, lack of enough resources to provide for children’s feeding, poor hygiene, also intensifies severe acute malnutrition. If the condition is not treated, it can turn into chronic malnutrition. This is very complicated. Such cases are common in Rwanda.

However, he says that some people ignore government health services, gross monitoring programmes because they have the means, yet such services are provided in government hospitals for free. Some people are still naive about when to feed the child on solid food; this is due to lack of knowledge yet this is what everyone who has a child should know.

He calls upon mothers to breastfeed their children at least up to two years. Immunisation is very important as it hinders kids from acquiring occasional diseases.

Nutritional treatment is based on the use of therapeutic foods enriched with vitamins and minerals, therapeutic milk is good for such patients (for use exclusively in hospitalised patients). F-75 therapeutic milk, low in protein, sodium and calories (0.9 g of protein and 75 kcal per 100 ml) is used in the initial phase of treatment for patients suffering from the illness, WHO states. 

UNICEF states, ending acute malnutrition is a complex social and political challenge. Prevention and long term solutions involve dismantling unequal power structures, improving equitable access to health services and nutritious foods, promoting breastfeeding and optimal infant and young child feeding practices, improving water and sanitation, and planning for cyclic food shortages and emergencies. But in the short term, children with severe acute malnutrition need urgent lifesaving treatment to survive.

Ready-to-use therapeutic food is a high-energy, micronutrient enhanced paste used to treat children under age five who are affected by severe acute malnutrition. As its name implies, RUTF does not need to be cooked or prepared before consumption, notes UNICEF.

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