Severe, Acute Malnutrition and Infection

Journal article

Severe acute malnutrition (SAM) is associated with increased severity of common infectious diseases, and death amongst children with SAM is almost always as a result of infection. The diagnosis and management of infection are often different in malnourished versus well-nourished children. The objectives of this brief are to outline the evidence underpinning important practical questions relating to the management of infectious diseases in children with SAM and to highlight research gaps. Overall, the evidence base for many aspects covered in this brief is very poor. We have tried to highlight where we are providing‘opinion’ rather than ‘evidence’. The brief is structured into sets of clinical questions, which we hope will maximise the relevance to contemporary practice. Children with SAM are classified as ‘complicated’ if they have clinical features of infection or metabolic disturbance, severe oedema or poor appetite. Children with ‘uncomplicated’ SAM are clinically well, alert and have retained their appetite. They should usually be managed as outpatients where suitable services with access to ready-to-use therapeutic food (RUTF) exist, whilst children with complicated SAM should be managed as inpatients. Thus, much of the information in this brief on infections relates to inpatient care, since children with features of infection usually require admission. However, an understanding of how children with infection present and initial management strategies are crucial for health workers dealing with new presentations of SAM, and for those dealing with complications and reassessing children for poor response to treatment during rehabilitation.

Authors: Berkley, J; Jones, K

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: CMAM forum
• Publication date: 2013-05-06
• DOI: 10.1179/2046904714z.000000000218
• EISSN: 2046-9055
• ISSN: 2046-9047
• Keywords: pneumonia; infection; malnutrition; wasting; kwashiorkor; antimicrobials; sepsis; measles; diarrhoea