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Referral and warning signs
When to refer
Complicated SAM -> Inpatient. Uncomplicated SAM -> OTC. MAM -> SFP/Counseling.
Red flags
- Bilateral pitting oedema
- MUAC < 115 mm
- WFH/L < -3 Z-score
- Any General Danger Sign
- Failed Appetite Test
Signs and symptoms
- Not applicable - Describes assessment methods.
Risk factors
- See NUT004.
Diagnosis
Clinical assessment
Systematic Assessment: 1. Check for Bilateral Pitting Oedema (press feet 3s). 2. Measure MUAC (<115mm SAM, 115-<125mm MAM). 3. Measure Wt & Ht/Lt -> Calculate WFH/L Z-score (<-3z SAM, -3 to <-2z MAM). 4. Look for Visible Severe Wasting. 5. Check for Medical Complications (IMCI Danger Signs). 6. Perform Appetite Test (if SAM & no complications) using RUTF. History (feeding, illness, TB/HIV).
Investigations
- Anthropometry (Wt, Ht/Lt, MUAC).
- Oedema check.
- Appetite Test.
- IMCI danger sign assessment.
- Consider HIV test, TB screen, stool analysis.
Diagnostic criteria
SAM: Oedema OR MUAC<115 OR WFH/L<-3z. Complicated SAM = SAM + Complication/Failed Appetite. Uncomplicated SAM = SAM + No Complication + Passed Appetite. MAM: MUAC 115-<125 OR WFH/L -3 to <-2z (No Oedema/SAM).
Management
Non-pharmacological management
- See NUT006 (MAM), NUT007 (Complicated SAM), NUT008 (Uncomplicated SAM).
Pharmacological treatment
- See NUT006 (MAM), NUT007 (Complicated SAM), NUT008 (Uncomplicated SAM).
Monitoring
- Depends on management pathway.
Complications
- See NUT004.
Prevention
- See NUT004.
Patient education
- How status assessed.
- Explanation of SAM/MAM.
- Importance of management plan.
Uganda-specific notes
MUAC widely used for screening. WFH/L needs equipment/training. Appetite test crucial for inpatient vs outpatient decision.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 19, Section 19.2.1.2 (Assessing Malnutrition, Diagnostic criteria table)
- Uganda Clinical Guidelines (UCG) 2023
Chapter 17, Section 17.5 (Growth Charts / MUAC info)
- Integrated Management of Acute Malnutrition Guidelines, MOH Uganda
(Detailed assessment protocols)