Mastering What is Severe Acute Malnutrition Quizlet Style

Affecting almost 20 million children under five globally, severe acute malnutrition (SAM) carries a significantly heightened mortality risk if left untreated. This guide provides a detailed breakdown of what is severe acute malnutrition, covering the definitions and concepts often found on educational platforms like Quizlet for easy comprehension.

Quick Summary

An educational breakdown covering the clinical definition of severe acute malnutrition (SAM), its types, diagnostic criteria, underlying causes, and modern treatment approaches recommended by the WHO.

Key Points

• Definition: Severe Acute Malnutrition (SAM) is a life-threatening condition defined by severe wasting, bilateral oedema, or a low Mid-Upper Arm Circumference (MUAC).

• Two Forms: Historically, SAM is classified as marasmus (severe wasting) or kwashiorkor (nutritional oedema), though treatment is often similar.

• Diagnosis: In children, SAM is diagnosed if MUAC is < 115mm, Weight-for-Height Z-score (WHZ) is < -3 SD, or if bilateral pitting oedema is present.

• Causes: Key causes include inadequate diet, infectious diseases, and socio-economic factors like poverty and poor sanitation.

• Treatment Approach: Modern SAM management uses a phased approach, with Ready-to-Use Therapeutic Food (RUTF) for uncomplicated cases and hospital care for complicated ones.

• Prevention: Prevention strategies focus on improving feeding practices, enhancing public health services, and addressing food insecurity and sanitation issues.

What is Severe Acute Malnutrition (SAM)?

Severe acute malnutrition (SAM) is a life-threatening condition resulting from recent and severe food restriction or illness. It is characterized by severe wasting, nutritional oedema, or both. The World Health Organization (WHO) and other international bodies define SAM using specific diagnostic criteria, primarily for children aged 6 to 59 months, though infants under six months are also highly vulnerable. A rapid decline in nutritional status can severely compromise the body's physiological functions and immune system, making a person highly susceptible to life-threatening infections. Early and effective management is crucial for survival and long-term health.

Diagnostic Criteria for SAM

According to WHO guidelines, SAM is diagnosed using a combination of anthropometric and clinical indicators. In children aged 6 to 59 months, the following are diagnostic features:

• Mid-Upper Arm Circumference (MUAC): A measurement less than 115 mm indicates SAM. MUAC is a highly effective and simple screening tool for identifying children at increased risk of mortality.
• Weight-for-Height Z-score (WHZ): A WHZ less than -3 standard deviations (SD) below the median of the WHO Child Growth Standards indicates severe wasting.
• Bilateral Pitting Oedema: The presence of bilateral pitting oedema (swelling, usually starting in the feet) is a clinical sign that automatically classifies a child as having SAM, irrespective of their WHZ or MUAC. This is a hallmark of the kwashiorkor form of malnutrition.

The Two Clinical Forms of SAM

Historically, SAM has been categorized into two main clinical presentations: marasmus and kwashiorkor. While modern treatment protocols often treat them similarly, understanding their distinctions is essential.

Feature	Marasmus	Kwashiorkor
Physical Appearance	Severely emaciated, skeletal appearance due to loss of muscle mass and fat.	Appears 'puffy' or swollen due to bilateral pitting oedema, especially in the hands, feet, and face.
Underlying Deficiency	Deficiency of all macronutrients (carbohydrates, proteins, and fats), resulting from a lack of total calories.	Primarily a protein deficiency, though often seen in individuals with some carbohydrate intake.
Weight	Very low weight for height (severe wasting).	Body weight can be deceptively high due to fluid retention, masking the underlying wasting.
Other Signs	Apathy, poor growth, loss of subcutaneous fat.	Fatty liver, skin changes (pigmentation changes, ulceration), brittle hair, anaemia.

Causes and Risk Factors of SAM

The causes of SAM are complex and multifaceted, often involving a combination of immediate and underlying factors.

Immediate Causes

• Inadequate Dietary Intake: Insufficient energy, protein, and micronutrients are the direct nutritional causes. This can be due to food scarcity, poor-quality diet, or inappropriate feeding practices.
• Infections and Disease: Recurrent infections like diarrhoea, pneumonia, and measles are a major cause, as they increase nutrient requirements while decreasing appetite and absorption. HIV is also a contributing factor in many high-prevalence areas.

Underlying and Basic Causes

• Poverty and Food Insecurity: Limited financial resources lead to reduced access to nutritious food and healthcare services.
• Lack of Sanitation and Clean Water: Unhygienic conditions increase the risk of infectious diseases, trapping individuals in a vicious cycle of malnutrition and infection.
• Lack of Education: Low parental education is correlated with a higher risk of malnutrition in children.
• Family Size: Larger family sizes can strain household resources and contribute to food insecurity.
• Emergency Situations: Droughts, famine, conflicts, and natural disasters exacerbate food shortages and instability.

Treatment and Management of SAM

Modern management of SAM follows a phased, evidence-based approach, distinguishing between uncomplicated (outpatient) and complicated (inpatient) cases.

Inpatient Treatment for Complicated SAM

Children with medical complications or lack of appetite require hospitalization. The treatment process includes:

1. Stabilization Phase (Days 1–7): Correcting life-threatening conditions like hypoglycaemia, hypothermia, and severe dehydration using specialized rehydration fluids like ReSoMal. This phase also involves treating infections with broad-spectrum antibiotics and correcting electrolyte imbalances. Feeding is initiated slowly with therapeutic milk (F-75).
2. Transition Phase (Days 8-10): A short phase to transition the child to a higher-energy therapeutic food, often F-100 milk, while monitoring tolerance.
3. Rehabilitation Phase (Weeks 2–6): Focuses on catch-up growth using high-energy ready-to-use therapeutic food (RUTF), like Plumpy'Nut. Iron supplementation is introduced at this stage.

Outpatient Treatment for Uncomplicated SAM

Children with a good appetite and no medical complications can be treated at home using RUTF, with regular check-ups. RUTF is a nutrient-dense, shelf-stable paste that is safe for consumption in non-refrigerated settings. The treatment course typically lasts 6 to 8 weeks until the child reaches sufficient weight gain and meets discharge criteria.

Prevention Strategies

Preventing SAM requires a multi-pronged approach addressing the underlying causes.

• Improved Infant and Young Child Feeding: Promoting exclusive breastfeeding for the first six months and appropriate complementary feeding practices is foundational.
• Better Access to Healthcare: Early detection and treatment of childhood illnesses can break the malnutrition-infection cycle.
• Enhanced Water, Sanitation, and Hygiene (WASH): Improving access to clean water and sanitation reduces the incidence of infections that contribute to malnutrition.
• Food Security and Livelihoods: Long-term strategies like supporting household food production and social protection programs are crucial for preventing malnutrition.

Conclusion

Understanding severe acute malnutrition is more than just memorizing flashcards on Quizlet; it requires appreciating the complex interplay of clinical signs, diagnostics, and humanitarian factors. Defined by severe wasting, oedema, or a very low MUAC, SAM is a medical emergency with high stakes. With proper diagnosis and treatment—whether inpatient for complicated cases or outpatient for uncomplicated ones using Ready-to-Use Therapeutic Foods—recovery is possible. Ultimately, addressing the root causes of poverty, food insecurity, and poor sanitation is key to preventing SAM and saving countless lives.

For further reading on SAM protocols and guidelines, consult the World Health Organization.

Frequently Asked Questions

What is the primary sign of kwashiorkor?

The primary clinical sign of kwashiorkor, a form of severe acute malnutrition, is the presence of bilateral pitting oedema, or swelling, which typically begins in the feet.

How is the mid-upper arm circumference (MUAC) used to diagnose SAM?

For children aged 6 to 59 months, a mid-upper arm circumference (MUAC) measurement of less than 115 mm is used as a diagnostic criterion for severe acute malnutrition (SAM).

What is the difference between SAM and chronic malnutrition?

SAM is characterized by acute, severe wasting (low weight for height) or oedema, often resulting from a recent crisis or illness. Chronic malnutrition, known as stunting, is indicated by low height for age and results from long-term deprivation.

What is RUTF and how is it used for treating SAM?

RUTF stands for Ready-to-Use Therapeutic Food. It is a high-energy, nutrient-dense paste used for the outpatient treatment of uncomplicated severe acute malnutrition, allowing children to recover at home.

Why are antibiotics given to children with SAM?

Children with SAM have a compromised immune system and are at high risk for infections. Broad-spectrum antibiotics are routinely administered, even without obvious signs of infection, to prevent and treat common, potentially fatal illnesses.

When does a child with SAM need inpatient care?

A child with severe acute malnutrition requires inpatient care if they have a lack of appetite, severe oedema (+++), or any other medical complications, such as hypoglycaemia, hypothermia, or shock.

What is refeeding syndrome?

Refeeding syndrome is a potentially life-threatening complication that can occur when severely malnourished individuals are fed too aggressively. It involves dangerous shifts in fluid and electrolyte levels and is why initial refeeding is done carefully under medical supervision.