➡️Introduction

There is rising risk of wasting and nutritional edema in infants and children, especially in high-risk contexts and ongoing crises as climate change and regional conflicts with expected increase of numbers of refugees, where health and socioeconomic factors are the poorest.

Despite that the national prevalence of wasting in under 5 children is 3% in 2021, there is higher prevalence in some Egyptian governorates, as South Sinai 15.9%, Aswan 14.1%, Suez 10.7%, Luxor 8.8%, Qalioubiya 6.8%, Cairo 5.4%, Giza 4.8% and Assuit 4.5%.

This guideline is adapted with permission from “WHO guideline on the prevention and management of wasting and nutritional edema (acute malnutrition) in infants and children under 5 years 2023”and “WHO guideline updates on the management of severe acute malnutrition in infants and children 2013” to help in achieving global targets for wasting and nutritional edema including Sustainable Development Goal 2 to reach “Zero Hunger” by 2030.

➡️Scope

This guidelinefocusses on prevention and management of acute malnutrition in under five infants and children with special consideration of infants less than 6 months of age at risk of poor growth and development, moderate wasting in infants and children 6-59 months of age, severe wasting and nutritional edema in infants and children 6-59 months of age, and prevention of wasting and nutritional edema from a child health perspective.

➡️Guideline development process and methods

After reviewing all the inclusion and exclusion criteria the GDG & methodologists recommended using 2 guidelines:

1- WHO guideline updates on the management of severe acute malnutrition in infants and children

(2013)

2- WHO guideline on the prevention and management of wasting and nutritional edema (acutemalnutrition) in infants and children under 5 years (2023)

We did Adolopment for these guidelines: (Adoption, Adaptation, and Development)

         - Adoption for most of the guideline recommendations.

         -  Adaptation for 2 recommendation according to GRADE criteria to be suitable to our Economic implications (Evidence to Decision (EtD) table was done)

         - Development of Good Practice Statement

Recommendations and good practice statements

This version of the guideline includes recommendations and good practice statements on the following four sub-sections:

A. Management of infants less than 6 months of age at risk of poor growth and development

The guideline covers infants less than 6 months who are not growing well, before they meet criteria for wasting and/or nutritional edema and consider the mother and infant as an interdependent unit.

This guideline emphasis on early identification and then provide appropriate immediate care or referral for both the infant and the mother/caregiver preventing later wasting and/or nutritional edema.      

This section includes recommendations and good practice statements on interventions for mothers/caregivers of infants at risk of poor growth and development, admission, referral, transfer, and exit criteria for infants at risk of poor growth and development, management of breastfeeding/lactation difficulties in mothers/caregivers of infants at risk of poor growth and development, supplemental milk for infants at risk of poor growth and development and use of antibiotics for infants at risk of poor growth and development.

B. Management of infants and children 6-59 months with wasting and/or nutritional edema

This section includes recommendations and good practice statements on admission, referral, transfer and exit criteria for infants and children with severe wasting and/or nutritional edema, identification of dehydration in infants and children with wasting and/or nutritional edema, rehydration fluids for infants and children with wasting and/or nutritional edema and dehydration but who are not shocked, ready-to-use therapeutic food for treatment of severe wasting and/or nutritional edema, dietary management of infants and children with moderate wasting and vitamin A supplementation in the treatment of children with severe acute malnutrition

C. Post-exit interventions after recovery from wasting and/or nutritional edema

D. Prevention of wasting and nutritional edema

We can summarize the guidelines for management of acute malnutrition in the following:

▪️  Nutritional status must not be seen in isolation. Assessment of an infant’s or child’s health and developmentalstatus (including triage and emergency care) is key for any decision-making for nutritional care and decisionson where this should be delivered.

▪️  Mothers and their infants less than six months at-risk of poor growth and development must be identified earlyand cared for as an inter-dependent unit. Effective and culturally appropriate care—especially for breastfeedingsupport—is vital for their current health as well as one of the most important preventative actions to reducethe prevalence of wasting and/or nutritional edema in later infancy and childhood.

▪️  Not all children with moderate wasting need a specially formulated food to supplement their diet. All childrenwith moderate wasting need a health assessment to rule out medical problems that could be the cause or maindriver of the moderate wasting. They also need access to a nutrient-dense home diet to meet their energeticand nutrient needs.

▪️  Some children with moderate wasting are at greater risk of mortality and non-recovery than others. These riskfactors are related to whether they live in a high-risk context (such as humanitarian crises) as well as specificindividual or social factors. These factors can be used to consider which children should be prioritized overothers to receive specially formulated foods (SFFs) which can be ready-to-use therapeutic food (RUTF), ready to use supplementary food (RUSF) or an improved fortified blended food to supplement their home diet.

▪️  Children with severe wasting and/or nutritional edema should receive nutritional treatment with an RUTFthat meets the Codex specification. The amount given can be either constant until anthropometric recovery orreduced if it is safe and appropriate to do so.

▪️  Community Health Workers can manage children 6-59 months of age with wasting and/or nutritional edema inthe community as long as they are adequately trained and receive ongoing supervision and support.This includes nutritional supplementation or treatment and medical care as appropriate to the context.