Community-based care for severely malnourished children

An innovative approach is showing progress in addressing severe acute malnutrition, which affects an estimated 20 million children under the age of five worldwide.

The approach combines community-based care for severely malnourished children with traditional hospital-based treatment.

A statement by the World Health Organization (WHO), the World Food Programme (WFP), the United Nations Standing Committee on Nutrition (SCN) and UNICEF issued today highlights new evidence that about three-quarters of children with severe acute malnutrition – those who have a good appetite and no medical complications – can be treated at home with highly fortified, ready-to-use therapeutic foods (RUTFs).

These are palatable, soft and crushable nutrient- and energy-rich foods that can be eaten by children over the age of six months without adding water, thereby reducing the risk of bacterial infection. RUTFs provide the nutrients required to treat a severely malnourished child at home, without refrigeration, and even where hygiene conditions are not perfect. The technology to produce RUTFs is relatively simple and could be used in all countries with high levels of severe acute malnutrition.

The traditional response to severe acute malnutrition has been to refer children to a hospital or specialized in-patient treatment unit, to be fed special milk-based diets. Though this treatment is effective, families may not have easy access to health facilities that could provide such care in the poorest countries where the majority of children with severe acute malnutrition live. In-patient treatment may not be an option for parents who simply cannot leave their homes for several weeks. In addition, severely malnourished children are vulnerable to infections as a result of weak immunity and could be at risk in crowded hospital wards.

When implemented on a large scale, and properly combined with hospital treatment for children with complications, community-based management of severe acute malnutrition could prevent the deaths of hundreds of thousands of children each year. The approach has already greatly improved survival rates for severely malnourished children in emergencies in such countries as Ethiopia, Malawi, Niger and Sudan. The aim is to expand the approach to reach the larger numbers of children suffering from severe acute malnutrition, who live in communities untouched by emergencies.

Severe acute malnutrition kills at least an estimated one million children each year - an average of one child every thirty seconds. These children are up to 20 times more likely to die than well-nourished children.

"The 20 million children under five in the world today who are suffering from severe acute malnutrition urgently need treatment. This integrated approach should provide a new impetus," said Dr Margaret Chan, WHO Director-General. "It is urgent that this approach, along with preventive action, be added to the list of cost-effective interventions being used to improve nutrition and reduce child mortality."

Emphasizing the importance of the three UN agencies partnering in this endeavour, Josette Sheeran, WFP Executive Director, said: "With this new approach, we have the right product composition to save millions of young lives – this is an example of the new technology and capacity which bring us closer to achieving the first Millennium Development Goal.”

The community-based approach brings services close to people's homes, so that families can identify children with severe acute malnutrition before the onset of life-threatening complications. Children are treated by health workers with basic oral medication and given a weekly supply of RUTF. Meanwhile, parents learn how to help malnourished children and pinpoint danger signs.

“Ready-to-use therapeutic foods have proven very effective in addressing severe acute malnutrition in children,” said UNICEF Executive Director and Chair of the SCN, Ann M. Veneman. “Malnuturition plays a part in some 53 per cent of the deaths of children under five years old, so these interventions are an important tool in reducing child mortality.”

The joint statement stresses the importance of measures including optimal infant and young child feeding, ensuring access to quality foods, improved water and sanitation systems and hygienic practices, and strengthening and improving access to health services.