Principles of the Integrated
Management of Acute
Malnutrition in Afghanistan
Outline
• Forms of Malnutrition
• Pathophysiology of Malnutrition
• Causes and Consequences of Malnutrition
• Overview of Malnutrition in Afghanistan
• IMAM Components
• Principles of IMAM Services
• IMAM Approach in Afghanistan
Forms of Malnutrition
Malnutrition comprises undernutrition and overnutrition.
Undernutrition:
• Undernutrition is the result of insufficient intake or absorption of proteins, carbohydrates,
lipids, vitamins, minerals and other nutrients essential for health and adequate growth.
• Undernutrition may result from inadequate food intake or disease, causing a nutrient
imbalance or malabsorption, increasing nutrient requirements or invoking nutrient losses.
Overnutrition:
• Overnutrition is the result of excess intake of nutrients, and includes overweight and obesity.
In these Guidelines, the term ‘malnutrition’ relates exclusively to undernutrition.
Forms of Undernutrition
• Acute malnutrition is characterised by a rapid deterioration in nutritional status
over a short period, resulting in nutritional oedema, wasting, or nutritional
oedema and wasting combined. Identified by bilateral pitting odema and or
inadequate weight for length or height (WHZ).
• Stunting is characterised by growth retardation resulting from chronic
undernutrition, identified by inadequate length or height for age (HAZ)
• Underweight is a combined indicator of nutritional status, reflecting both
chronic and acute malnutrition, identified by inadequate weight for age (WAZ)
• Micronutrient deficiencies are the result of inadequate intake, absorption or
utilization by the body of a specific vitamin or mineral and encompass a wide
range of symptoms and disorders, identified by clinical examination or
biomedical tests.
Forms of Acute Malnutrition
• Moderate Acute Malnutrition (MAM): Defined by moderate wasting
• Severe Acute Malnutrition (SAM): Defined by nutritional oedema and/or
severe wasting.
• The presence of anorexia or poor appetite and medical complications are
clinical signs indicating the severity of disease progress and classifies
SAM in uncomplicated and complicated SAM.
• The terms marasmus (severe wasting), kwashiorkor (nutritional oedema)
and marasmic-kwashiorkor (severe wasting and nutritional oedema
combined) are used to describe the clinical manifestations of SAM.
Pathophysiology of Malnutrition
• Malnutrition is a process that occurs over time resulting from an
imbalance in essential macro- and micronutrients.
• Because of the profound physical and metabolic changes, the health
of a child with acute malnutrition may rapidly deteriorate over a short
period.
Consequence of Malnutrition
Motor and cognitive
Health consequences Economic consequences
development consequences
Short-term Increased risk of premature death Delayed motor skills (sitting, standing Health costs
and walking)
Increased risk of infectious
diseases such as diarrhoea, Delayed cognitive development
pneumonia and measles (learning)
Long-term Increased risk of overweight later Delayed cognitive and language Lower aerobic capacity affecting physical
in life with associated higher risk ability at 5 years of age work
of hypertension, coronary heart Reduced likelihood of formal
disease, stroke and type II diabetes Impaired learning in school employment
10% lower earning than non-stunted
Higher risk of complicated labour Lower score in development tests and individuals
and retarded foetal growth school performance 1% loss in adult height due to childhood
stunting associated with 1.4% loss in
economic productivity
Causes of Malnutrition
Nutrition status of all children U5 –
NNS 2013
WHO cut offs for WHO cut offs for WHO cut offs for
VERY HIGH LEVEL VERY HIGH LEVEL VERY HIGH LEVEL
Underweight >30% Stunting >40% GAM > 15%
SAM > 4%
The Aim of IMAM and IMAM
Components
The aim is to reduce mortality and morbidity in
children under 5 years of age due to acute
malnutrition and associated disease.
1. Community outreach for community
awareness and involvement, and early
detection and referral
2. OPD-MAM for the treatment of MAM in
children 6–59 months of age and in PLW
3. OPD-SAM for the treatment of uncomplicated
SAM in children under 5 years of age
4. IPD-SAM for the treatment of complicated
SAM in children under 5 years of age
Key Principles of IMAM…
1. Maximum access and coverage
Goal: Bring treatment close to the people and make it less costly to
access by having many decentralised sites and regular (weekly or
biweekly) outpatient services.
2. Timeliness
Goal: Start treatment before the onset of life-threatening illnesses.
Key Principles of IMAM
3. Appropriate medical care and nutrition rehabilitation
Goal: Provide the right treatment to children in need.
4. Care as long as it is needed
Goal: Reduce barriers to access and prevent relapse.
IMAM Approach in Afghanistan…
IMAM Approach in Afghanistan
Thank You!
