Moderate acute malnutrition (MAM) *New*

ICD-10 code: E44.0

Description
General measures
Medicine treatment
Referral

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DESCRIPTION

Children and infants older than 6 months who have either:

• A WHZ-score between -2 and -3.
• MUAC between 11.5 cm and 12.5 cm.
• No pitting oedema or SAM danger signs (see Severe acute malnutrition (SAM)).
• Good appetite.

All cases require careful assessment for possible TB or HIV.

GENERAL MEASURES

• Provide ready to use therapeutic food (RTUF) and/or other nutritional supplements according to supplementation guidelines.
• Counsel according to IMCI guidelines.
• Follow-up frequently to ensure that the child gains weight and remains well.
• Discharge with supplementation, once the following criteria are met:
  • WHZ (weight-for-height z-score): > -2 WHZ for two consecutive visits at least one month apart and/or
  • MUAC: > 11.5 cm (preferably at 12 cm, if MUAC used alone).
• Follow patients for at least 6 months to ensure sustained growth.

MEDICINE TREATMENT

Do not repeat if child has received these during inpatient stay:

Give an additional dose of Vitamin A:

• Vitamin A (retinol), oral.

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LoE:IVb⁹

• Multivitamin, oral, daily.

LoE:IVb¹⁰

Empiric treatment for worms:

• Mebendazole, oral.
  • Children 1 - 2 years: 100 mg 12 hourly for 3 days.
  • Children > 2 - 5 years: 500 mg as a single dose.

LoE:IVb¹¹

OR

• Albendazole, oral, single dose.
  • Children 1 - 2 years: 200 mg as a single dose.
  • Children ≥ 2 years and adults: 400 mg as a single dose.

LoE:IIb¹²

REFERRAL

• No response to treatment.
• All children other than those with insufficient food intake (If there is inadequate food intake, refer to a social worker, if available).
• Severe malnutrition.
• Children showing developmental delay to be referred for rehabilitation.

LoE:IIIb¹³

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 Edition