WHO issues new guidelines for treating severe acute child malnutrition
November 29, 2013 - The United Nations health agency has released new treatment guidelines
for the almost 20 million children under the age of five worldwide who have severe
acute malnutrition, including options for allowing them to recover at home, as well
as treating those with HIV. “The guidelines are critical because many national health
plans currently overlook children with severe acute malnutrition. This can be fatal.
If these children don’t get the right medical and nutritional care, very often they
die,” said Dr. Francesco Branca, Director of the Department of Nutrition for Health
and Development at the World Health Organization (WHO) on Nov. 27. According to
WHO, severe acute malnutrition is when children suffer severe wasting that may or
may not be accompanied by swelling of the body from fluid retention. It occurs when
infants and children do not have adequate energy, protein and micronutrients in their
diet, combined with other health problems such as recurrent infections. It is diagnosed
when the circumference of the upper arm is less than 115 millimetres or when the weight
for height of a child is severely reduced. The updated WHO guidelines recommend that
children with severe acute malnutrition who do not have health complications that
require hospitalization, receive special, high-energy food and antibiotics to treat
infection. This allows them to recover at home with their families. “It’s generally
better for children and better for their families if they’re treated as outpatients,”
said Dr. Elizabeth Mason, Director of WHO’s Department of Maternal, Newborn, Child
and Adolescent Health. “It can be easier for families who need to continue providing
and caring for other children, and it allows vulnerable, malnourished children to
stay home and avoid the risk of getting hospital infections.” The new guidelines
also address how to treat children with severe acute malnutrition for HIV and offer
recommendations on treating severely malnourished infants under six months. They supersede
WHO’s 1999 guidelines which recommended that all severely malnourished children be
hospitalized, given fortified formula milk and appropriate treatment including antibiotics.
While the proactive use of antibiotics is important because the immune system of a
child who is severely malnourished can virtually shut down, the new recommendation
advocates this specifically for children with severe acute malnutrition – not those
who are simply undernourished. “Widespread use of antibiotics among children who do
not need them would increase the risk of infections becoming resistant to lifesaving
antibiotics – a situation that would harm the health and survival of all children,”
WHO pointed out. Another new aspect relates to the treatment of severely malnourished
children with HIV. The 1999 guidelines did not recommend HIV testing of children with
severe acute malnutrition. At that time, there was poor availability and little experience
of treating children with antiretroviral drugs. “Circumstances today are very different,”
WHO noted. “We now know that antiretrovirals significantly increase survival of children
with HIV, and access to these drugs is improving.” The new guidelines recommend
that children with severe acute malnutrition in countries where HIV is common be routinely
tested for the virus, and those who are positive should start on antiretroviral drugs
as well as special foods and antibiotics to treat their severe malnutrition. Also
addressed for the first time are the needs of infants under the age of six months
with severe acute malnutrition. WHO recommends that all babies under six months are
exclusively breastfed for optimal nutrition and protection against infections, adding
that this is particularly important for babies who are severely malnourished. “If
there is no realistic prospect of a severely malnourished baby being breastfed, the
family may need breast milk from another woman, e.g. a family member, a neighbour,
a wet nurse or a milk bank. If this is not possible, they will need infant formula
and support to prepare and use it safely,” WHO said.