Despite the gains to improve the nutrition status of children under-5 years old, there are still nutrition issues that could impact a child’s survival and development. And, acute malnutrition is among the pressing problems in nutrition. Acute malnutrition is a form of malnutrition that resulted from inadequate energy and/or protein intake, illness, or inappropriate childcare which lead to weight loss or the development of bilateral pitting edema.
Acute malnutrition can be classified into moderate acute malnutrition (MAM) or severe acute malnutrition (SAM). The severity of acute malnutrition is assessed through mid-upper arm circumference (MUAC) and z-score for the weight for height/length (WFH/L). Children who are identified as SAM are nine times more likely to die. Although MAM children have increased risk of death compared to normal children, the increase is relatively small compared to the increased risk of SAM children.
The criteria for classifying the degree of acute malnutrition for 6-59 months old children are:
Moderate Acute Malnutrition
- MUAC: ≥11.5cm to <12.5cm
- WFH/L z-score: -3 to < -2 SD
Severe Acute Malnutrition
- MUAC: <11.5cm
- WFH/L z-score: <-3 SD
- Presence of bilateral pitting edema
To properly manage acute malnutrition in the country, the Department of Health (DOH) adopted the Integrated Management of Acute Malnutrition (IMAM). It is a community-based program that uses standardized medical and therapeutic care protocol that was proven effective to address acute malnutrition globally.
Philippine Integrated Management of Acute Malnutrition (PIMAM) is one of the nutrition-specific programs of the Philippine Plan of Action for Nutrition (PPAN) 2017-2022 which focuses on the management of MAM and SAM. Also, PIMAM relies heavily on community participation in the prevention and treatment of acute malnutrition. And, this approach was initially introduced in the country in 2018 as part of the Nutrition in Emergencies (NiE) interventions covering 6 to 59 months old children in disaster-affected communities.
To scale up intervention against acute malnutrition, the DOH issued the Administrative Order No. 2015-0055 with the subject “National Guidelines on the Management of Acute Malnutrition for Children under 5 years”. This order provided a strategic framework as a guide for a multisectoral approach in the implementation of PIMAM.
Under the PIMAM program, community health and nutrition workers are capacitated to identify, assess and treat MAM and SAM cases. For the early identification of possible MAM and SAM cases, health and nutrition workers assess the 6-59 months old children using the aforementioned criteria. Children diagnosed with acute malnutrition are automatically referred for a full assessment and admitted for inpatient or outpatient care depending on their condition.
Children referred to inpatient therapeutic care (ITC) are SAM cases with medical complications and lack of appetite. This is to appropriately manage their medical condition and provide complete nutritional rehabilitation by giving therapeutic milk or Ready-to-Use Therapeutic Food (RUTF). Meanwhile, outpatient therapeutic care (OTC) is the treatment for SAM children with appetite and no medical conditions, thereby, they are treated at home with provisions of RUTF and simple routine medicines.
Further, children with MAM are treated at home with Ready-to-Use Supplementary Food (RUSF) or locally available supplementary foods plus routine health care. Parents and/or caregivers of MAM and SAM children are also provided with intensive nutrition counseling.
Through the PIMAM, there is still hope for SAM and MAM children. In Northern Mindanao, there are several success stories of SAM rehabilitation. One of which is the story of Nardo, a 35-month-old baby boy of Brgy. Igpit, Opol, Misamis Oriental.
With community engagement in seeking health and nutrition services and appropriate intervention, acute malnutrition can be prevented and treated. Ultimately, the PIMAM goal is to lower, if not zero out, the rate of acute malnutrition in the country. Sa PIMAM ng PPAN, panalo ang bayan! (NO II Arlie Joy O. Damiles)
References:
Action Against Hunger. February 2009. Acute Malnutrition, A Preventable Pandemic.
DOI: https://www.actionagainsthunger.org/sites/default/files/publications/Acute_Malnutrition_A_Preventable_Pandemic_01.2009.pdf
Department of Health. Administrative Order No. Order No. 2015-0055. National
Guidelines on the Management of Acute Malnutrition for Children under 5 years. Retrieved from: https://nnc.gov.ph/phocadownloadpap/userupload/elavapie/AO%202015-0055.pdf
Department of Health. May 2020. Training Module. National Guidelines on the
Management of Moderate Acute Malnutrition for Children under Five Years. Retrieved from: https://docs.wfp.org/api/documents/WFP-0000116054/download/
Ramos, H. (2016, November). Philippine Integrated Management of Severe Acute
Malnutrition (PIMAM) [Slides].
https://www.nnc.gov.ph/phocadownloadpap/userupload/elavapie/Philippine%20Integrated%20Management%20of%20Acute%20Malnnutrition.pdf
United Nations International Children's Emergency Fund. June 2015. Manual of
Operations. National Guidelines on the Management of Severe Acute Malnutrition for Children under Five Years. Retrieved from: https://unicefeapronietoolkit.files.wordpress.com/2017/08/1-the-philippines-sam-guidelines-2015-final-print-ready.pdf
