SAM, although may sound like our next door's neighbor, actually stands for severe acute malnutrition. Malnutrition encompasses both under and over nutrition; however, in this context, it is more in the lines of the former. It is usually a problem plaguing third world countries such as Sub-Saharan Africa and has hence led to the creation of specific management guidelines appropriate for the setting.
The severe and acute descriptions show the urgency and care needed in treating this condition. It mostly affects children as they are nearly fully dependent on their caregivers for nutrition and as well as more heavily affected by diseases. We then have both our primary and secondary causes of malnutrition, the former being due to lack of essential nutrients and the latter, of the lack of proper utilization of those nutrients in the body.
We have various units such as weight, length/height and place them in plotted graphs (CDC or WHO) to make sense of our measurements. To objectively diagnose a child with SAM, their age plays a part as well. For those under 6 months, it is either the weight for length is < 3 SD (standard deviation) or there is a presence of bilateral pitting edema not due to other causes. For those above up to 59 months, it includes the above two or MUAC (mid upper arm circumference) <11.5 cm.
However, it is wise to remember most children present with complications before they can be labeled as SAM patients. These include poor appetite, intractable vomiting, convulsions, lethargy, unconsciousness, high fever, dehydration, persistent diarrhea, severe anemia, hypoglycemia, hypothermia, severe skin infections and eye signs of vitamin A deficiency. Long term complications include stunting and over all higher susceptibility to diseases as an adult.
When it comes to management of the above conditions, we have to be aware that they are in the state of reductive adaptation and so have to be treated differently. The odd term in the above sentence would have to be reductive adaptation. A simple definition is the shutting down of the body as organ systems slowdown in order to allow survival with limited calories. So, for example, if rapid feeding is initiated, it would be overwhelming to the body and cause complications of its own. Hence, we divide the treatment process into 3 phases: stabilization, transition and rehabilitation phases, each with their special types of formula milk, hydration mix and criteria to either progress or revert in between phases.
In the stabilization phase, we mostly treat the complications and don't really expect any weight gain, but in the latter 2 phases, we prime the body back out of its adaptive state and into normal metabolism. All this takes time and resources as well as careful monitoring of the patient's status. So as always, prevention is better than cure and this can range from proper nutritional intake to efficient national economic and political policies so as to protect the young from starvation and both its short- and long-term consequences.
References
Generation, V. (2020, October 14). Illustration abstraite de vecteur de concept de famine et de malnutrition. Dreamstime. https://fr.dreamstime.com/illustration-abstraite-vecteur-concept-famine-malnutrition-faim-probl%C3%A8me-ressource-manque-sensibilisation-population-image198854679
Government of Ethiopia, Federal Ministry of Health, 2019. Training course on the management of acute malnutrition, Participant module.
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