Model Answer
0 min readIntroduction
Malnutrition remains a significant public health challenge globally, particularly affecting children under five years of age. The World Health Organization (WHO) provides a standardized classification system to diagnose and manage malnutrition, enabling effective interventions. Accurate diagnosis is paramount for appropriate treatment and reducing child mortality. Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM) are the two primary categories, with SAM requiring immediate and intensive care. This answer will detail the diagnostic criteria for severe malnutrition as defined by the WHO.
WHO Classification of Severe Malnutrition
The WHO classifies severe malnutrition into two main types: Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM). This answer will focus on SAM.
1. Severe Acute Malnutrition (SAM)
SAM is a life-threatening condition requiring urgent medical attention. It is further categorized into:
- Marasmus: Severe wasting, with little or no edema.
- Kwashiorkor: Edema, often with dermatological lesions and changes in hair color.
- Marasmic-Kwashiorkor: A combination of both marasmus and kwashiorkor.
2. Diagnostic Criteria for SAM
Diagnosis of SAM is based on a combination of anthropometric measurements, clinical signs, and edema assessment. The following criteria are used:
- Weight-for-Height:
- Z-score < -3
- Or, Weight < 70% of median weight-for-height
- Mid-Upper Arm Circumference (MUAC):
- < 12.5 cm (or 11.5 cm if edema is present)
- Presence of Nutritional Edema:
- Bilateral pitting edema extending to the feet. This is a key indicator of Kwashiorkor.
- Clinical Signs:
- Very thin appearance with visible wasting
- Severe lethargy or apathy
- Visible bony prominences
3. Operational Definition for SAM in Community Settings
In resource-limited settings, a simplified approach is often used for initial screening:
- MUAC < 12.5 cm, *regardless* of edema.
- Visible severe wasting *and* no edema.
- Visible severe wasting *with* edema.
4. Differentiating SAM from MAM
Moderate Acute Malnutrition (MAM) is less severe and does not typically require hospitalization. The diagnostic criteria for MAM are:
- Weight-for-Height: Z-score between -2 and -3
- MUAC: 12.5 cm to 13.5 cm
- Presence of Edema: Absence of nutritional edema
Important Note: The WHO guidelines emphasize that clinical assessment should always accompany anthropometric measurements. A child meeting only one criterion may not necessarily be classified as severely malnourished, and a comprehensive evaluation is essential.
| Criteria | Severe Acute Malnutrition (SAM) | Moderate Acute Malnutrition (MAM) |
|---|---|---|
| Weight-for-Height Z-score | < -3 | -2 to -3 |
| Weight-for-Height (% of median) | < 70% | 70-80% |
| MUAC (cm) | < 12.5 (or 11.5 with edema) | 12.5 - 13.5 |
| Edema | Present or Absent | Absent |
Conclusion
Accurate diagnosis of severe malnutrition according to WHO criteria is crucial for timely intervention and improved child survival rates. Utilizing a combination of anthropometric measurements, clinical assessment, and edema evaluation allows for effective identification of children requiring urgent medical care. Strengthening community-based screening programs and ensuring access to appropriate treatment protocols are essential steps in combating malnutrition globally. Continuous monitoring and evaluation of these programs are vital for optimizing their impact.
Answer Length
This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.