SEVERE AND MODERATE ACUTE MALNUTRITION (SAM AND MAM)

While chronic malnutrition is more common, children with acute malnutrition are at highest risk of death and serious complications, who need immediate medical attention.

Hence, for the purpose of management, WHO/ UNICEF in recent years has categorized acute mal­nutrition as severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), to standardize management strategies (Table 6.7).

Severe acute malnutrition (SAM) is defined as presence of any one of the following criteria in children 6 months to 5 years:

• Weight for length/height lt; - 3 SDS or z-score,

• Mid-upper arm circumference lt;11.5 cm,

• Presence of bilateral pedal edema.

In addition, IAP guidelines also include visible wasting as an additional criteria for SAM, though it is highly subjective and should be used only if: (a) anthropometric parameters, e.g. Wt, Ht and MUAC are not available; or (b) length is lt;45 cm, as weight for length charts are not available for children measuring lt;45 cm.

Moderate acute malnutrition (MAM) is defined as presence of any one of the following criteria in children 6 months to 5 years:

• Weight for length/height between -2 and -3 SDS or z-score,

• Mid-upper arm circumference between 12.4 cm to 11.5 cm.

TABLE 6.7: Diagnostic criteria for SAM and MAM in children

MUAC: Mid-upper arm circumference

In children below 6 months, same criteria may be used for diagnosis of SAM and MAM except MUAC and including those with visible wasting as SAM.

6.1.5