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

World Health Organisation, 1999

By Jean Long, Course Co-ordinator International Health, Trinity College Dublin

Malnutrition remains one of the most common causes of morbidity and mortality throughout the world. Approximately 9% of children below 5 years of age suffer from wasting and are at risk of death or severe impairment of growth and psychological development.

The manual is based on the treatment of severe protein energy malnutrition, which was published by WHO in 1981. Many advances have been made in the treatment of severe malnutrition since the earlier WHO publication, for example:

• an improved oral rehydration salts solution (ORS) has been developed for the treatment of dehydration in individuals with severe malnutrition;
• advances in the knowledge of the physiological roles of micronutrients have led to improved dietary management in the initial phase of treatment;
• physical and psychological stimulation as well as care and affection have been shown to be necessary during the rehabilitation phase in order to prevent retardation of growth and psychological development'.

The manual is intended for health personnel (including physicians, nurses, midwives and auxiliaries) working in the health sector at national and district level and provides guidelines for the treatment of severely malnourished children (below 5 years of age) in hospitals and health centres. The treatment of severely malnourished adolescents and adults is also briefly considered, as well as the treatment of persons in refugee camps.

This manual has updated information on the clinical treatment of severe malnutrition in children less than five years. The clinical guidelines are comprehensive and would be useful for training or updating health professionals working in hospitals and health centres. However, there is no reference to the treatment of children between 5-10 years old while the section on adolescent and adult malnutrition could be developed better. The guidelines presented on failure to respond to treatment are excellent. The section on physical and psychological stimulation is also well presented and informative. The guidelines on caring practices and education/counselling are limited though their importance in relation to recovery and relapse is recognised.

For further information contact: WHO Distribution and sales, CH-1211 Geneva 27, Switzerland. Phone: +41 22 791 4857, Fax: +41 22 791 2476. email: publications@who.org