Admission

Admission, for the purpose of this guideline, refers to a child being registered and entering inpatient care as a patient. This is distinguished from the term “enrolment”, which is used for outpatient care.

Anthropometric recovery

For the purpose of this guideline, this refers to weight-for-height (WHZ)/weight-for-length (WLZ) z-score equal to or greater than 2 standard deviations (SD) below the WHO child growth standards median (WHZ or WLZ ≥ -2) and a mid-upper arm circumference (MUAC) equal to or greater than 125mm (in children 6-59 months) observed for at least 2 consecutive outpatient care visits. Before any decisions can be made regarding exit from nutritional treatment these anthropometric measurements need to be accompanied by an assessment of nutritional edema: a child must also be free of nutritional edema for at least two consecutive visits to meet exit criteria.

Caregiver

For the purpose of this guideline, a caregiver refers to a person, often a family member, who provides direct and regular care and support to an infant or child. This term is used in this guideline to emphasize that the father and other family members or non-related people can play a vital role in looking after children, in addition to (or even instead of) the mother; this may be even more relevant as the child grows older and is less likely to be breastfed.

Discharge

For the purpose of this guideline, discharge refers to a child finishing their inpatient care and leaving to go back home. This is distinguished from the term “exit” which is used for outpatient care.

Enrolment

For the purpose of this guideline, enrolment refers to a child being registered into outpatient care where nutritional supplementation or treatment is provided on a regular basis (see outpatient care). This is different to the term “admission” which is used for inpatient care.

Exit

For the purpose of this guideline, exit refers to a child finishing their nutritional treatment or supplementation and no longer attending outpatient care. This is distinguished from the term “discharge” which is used for inpatient care.

Health professionals

Health professionals’ study, advise on or provide preventive, curative, rehabilitative and promotional health services based on an extensive body of theoretical and factual knowledge in diagnosis and treatment of disease and other health problems. They may conduct research on human disorders and illnesses and ways of treating them and supervise other workers. The knowledge and skills required are usually obtained as the result of study at a higher educational institution in a health-related field for a period of 2–7 years leading to the award of a first degree or higher qualification. Health professionals include doctors, nurses, midwives, physiotherapists, dentists, paramedical practitioners.

Health workers

Health workers make up the health workforce and are people engaged to deliver health care to individuals and populations as part of the health system. Health workers are divided up into five main categories: health professionals, health associate professionals, personal care workers in health services, health management and support personnel, and other health service providers not elsewhere classified.

Infants at risk of poor growth & development

Infants less than 6 months who are not growing well before they meet the criteria of wasting and/or nutritional edema.

Inpatient care

For the purpose of this guideline, inpatient care refers to medical care, nutritional supplementation or treatment, and feeding support (for both breastfed and non-breastfed infants) which is delivered in a health facility involving the child staying for one or more nights in the health facility itself.

Moderate acute malnutrition (MAM)

-  WHZ or WLZ < -2 and/or

-  MUAC ≥ 115 and <125mm and

- No nutritional edema.

Mother/caregiver-infant

This term is used predominantly in relation to infants less than 6 months of age to highlight the importance of providing services for the mother/caregiver-infant pair together with a holistic approach encompassing all their physical and mental health and nutrition needs and recognizing the interdependence of this unit, especially in the early months of an infant’s life.

Nutrient-dense foods

Nutrient-dense foods are those high in nutrients relative to their caloric content that is they have a relatively high content of vitamins, minerals, essential amino acids and healthy fats. Examples of nutrient-dense foods include animal-source foods, beans, nuts, and many fruits and vegetables.

Nutritional supplementation (for moderate wasting)

For the purposes of this guideline, nutritional supplementation is used to describe the regular outpatient services, whereby infants and children with moderate wasting receive medical care and nutritional supplementation to achieve clinical and anthropometric recovery, as well as referring them to ongoing appropriate preventative and supportive services if needed and possible.

Nutritional treatment (for severe wasting and/or nutritional edema)

For the purpose of this guideline, nutritional treatment is used to describe the regular outpatient services, and potentially inpatient services (if needed), whereby infants and children with severe wasting and/or nutritional edema receive therapeutic milk or ready-to-use therapeutic food (RUTF) to help achieve anthropometric recovery and the resolution of nutritional edema. Nutritional treatment should always be delivered alongside medical care and referral to appropriate preventive and supportive services as needed.

Outpatient care

For the purpose of this guideline, outpatient care refers to medical care, nutritional supplementation or treatment (for children 6-59months) and feeding support (for both breastfed and non-breastfed infants) which is delivered in a health facility, and which does not require an overnight stay, but involves regular appointments (often referred to as visits) with a health worker until the child reaches clinical and anthropometric recovery. This health worker could be a health professional such as a doctor or nurse, or a health associate professional such as a community health care worker.

Psychosocial stimulation

Psychosocial stimulation can be defined as the sensory information received from interactions with people and environmental variability that engages a young child’s attention and provides information; examples include talking, smiling, pointing, enabling, and demonstrating, with or without objects. This also includes responsive feeding as a part of responsive caregiving.

Ready-to-use supplementary food (RUSF)

RUSF is a fortified lipid-based paste/spread used for the supplementation of children with moderate wasting. It should not be used for the nutritional treatment of severe wasting and/or nutritional edema.

Ready-to-use therapeutic food (RUTF)

RUTF is a food for special medical purposes (Codex Alimentarius) and includes pastes/spreads and compressed biscuits/bars used for the nutritional treatment of children with severe wasting and/or nutritional edema.

Referral

Referral, for the purpose of this guideline, refers predominantly to a child being referred to inpatient care from outpatient care. A malnourished child might however also get referred to other services such as HIV or TB (tuberculosis) care) for follow-up.

Severe acute malnutrition (SAM)

-  Nutritional edema and/or

-  WHZ or WLZ < -3 and/or

-  MUAC <115mm

Specially formulated foods (SFFs)

For the purpose of this guideline, specially formulated foods are defined as foods that have been specifically designed, manufactured, distributed, and used for either: special medical purposes or for special dietary uses, as defined by Codex Alimentarius.

Transfer (from inpatient to outpatient care)

For the purpose of this guideline, transfer describes the patient movement when a child is discharged from inpatient care to finish their nutritional treatment in outpatient care. They usually go home from the hospital and then attend an outpatient center/clinic for nutritional treatment at a later date and then regularly until clinical and anthropometric recovery.