4.

4
2

Introduction to
Nutrition Care Plans & Support

4.2 L E A R N I N G O B J E C T I V E S
1. Select appropriate Nutrition Care Plans
based on clients nutritional status.

4.3

C R I T E R I A F O R N O R M A L N U T R I T I O N A L S TAT U S

Adults
BMI 18.5 to 24.9 kg/m2
MUAC 230 mm

Pregnant/post-partum
women
MUAC 230 mm

Adolescent

4.4 N U T R I T I O N

C A R E F O R N O R M A L N U T R I T I O N A L S TA T U S

Counselling to prevent infection and

malnutrition
Critical Nutrition Actions
Child spacing and reproductive health
Optimal infant and young child feeding
Micronutrient supplementation
Deworming
Malaria prevention

4.5 C R I T E R I A F O R M A M
Adolescent

Adults

BMI for age Z score between 3

BMI: 16.0 to 18.4 kg/m and 2
2

MUAC: 190 to 229 mm MUAC:

Unintentional weight loss of 125%
- 10%
to 14
years: 160 to 184

mm
15 18 years: 185 to 219
mm
MUAC 190 to 229 mm Unintentional weight loss of
Weight gain: less than 1kg last
5% visit
- 10%

Pregnant/post-partum

women

4.6

NUTRITION CARE FOR

CLIENTS WITH MAM

Treatment of concurrent illnesses

CSB to provide 4060% of energy needs
Anaemia assessment (supplementation if
necessary)
Counseling on the CNA and WASH
Monthly follow-up and monitoring
Referral to programmes for economic
strengthening livelihoods and food
security support

4.7

T R A N S I T I O N F R O M M O D E R AT E T O N O R M A L N U T R I T I O N
S TAT U S

Adults
BMI > 18.5 kg/m2
MUAC 230 mm

Adolescent
BMI for age Z score > 2

MUAC
12 to 14 years:
185 mm

Pregnant/post-partum
women
MUAC 230 mm

15 to 18 years: 195
mm

4.8 C R I T E R I A F O R S A M
Adults
BMI < 16.0 kg/m2
MUAC < 190 mm
Weight loss > 10% since the last visit

Pregnant/post-partum
women
MUAC < 19.0 cm
Any weight loss

4.9 A D U LT W I TH SA M

4.10 NUTRITION CARE FOR CLIENTS

WITH SAM

Routine SAM medicines

Ready-to-use therapeutic food (RUTF)
High-energy fortified-CSB or Likuni Phala
Counselling on the CNA
bi-weekly monitoring (daily if inpatient)

Appetite test, oedema assessment, weight

monitoring and medical checks on each visit

Referral to programmes for economic

strengthening livelihoods and food security
support (ES/L/FS)

4.11

C R I T E R I A F O R O U T PA T I E N T T R E A T M E N T O F S A M

ALL OF THE FOLLOWING:

Severe malnutrition measured by bilateral

pitting oedema OR severe wasting OR
MUAC or BMI for age Z-score, BMI for nonpregnant/post-partum adults and MUAC for
pregnant/post-partum women
Passed an appetite test
No concurrent infections or other medical
complications

4.12

C R I T E R I A F O R I N PAT I E N T T R E AT M E N T O F S A M

Severe malnutrition measured by bilateral

pitting oedema OR MUAC OR BMI for age zscore , BMI for non-pregnant/post-partum
adults and MUAC for pregnant/post-partum
women
AND ANY OF THE FOLLOWING:

Failed an appetite test

Concurrent infections or other medical
complications that require hospitalisation.

TREATMENT IN THE INPATIENT

PHASE 1:
F75 is used to stabilise patients In phase 1
Treat infectious and other medical problems
Provide sufficient energy and nutrients to stop further loss of
muscle and fat tissue
Correct fluid and electrolyte imbalance

Preparation of F75
Mix 1 packet of F75 with 2 litres of cooled boiled water
to make 2400ml of formula

Amounts to give
Class of Wt 8
6 feeds
(kg)
feeds/day
/day
ml for each
feed

5 feeds/
day

15.0-19.9

260

300

400

20.0-29.9

300

350

450

30-60

350

400

500

Other factors to consider

Patients <15kg to be referred to NRU
IV fluids are discouraged as they have little nutritional
value and can cause fluid overload
Patients should not eat any other foods in Phase 1
unless they have diarrhea
Give ReSomal if a patient has diarrhea

Transition Phase
If patient in Phase 1 has returned or has a good appetite
move the patient into Transition Phase
The only change in this phase is the use of F100 in
place of F75
Other factors as No. of feeds, timing and volume is the
same
RUTF can be introduced-1 pot over 2 day transition
period

F100 Preparation
Mix 1 packet of F100 to 2 litres of cooled boiled water to
make 2400ml of Formula

Amounts to give
Class of Wt 8
6 feeds
(kg)
feeds/day
/day
ml for each
feed

5 feeds/
day

15.0-19.9

260

300

400

20.0-29.9

300

350

450

30-60

350

400

500

Other factors to be considered

Move to phase 2 after 2 days
Patients on NG feeding can stay in Transition for a
longer period but review after two weeks

Criteria to move back to Phase 1

If any signs of overload develop
If tense abdominal distension develops
Re-feeding diarrhea experience so that there is weight
loss

Phase 2
Achieve rapid weight gain
Requires more energy, proteins and micronutrients than
in phase 1
F100 is used in this phase as it it is high energy milk
If clinically indicated give one tablet of iron/folic acid.

Amounts to give
Class of wt
(kg

6 feeds per
24 hours
ml per feed

5 feeds per
24 hours
ml per feed

15.0-19.9

550

650

>20

750

900

Phase 2 using approved RUTF

RUTF can be used in Phase 2 if the patient is well and
can tolerate solid food
Treatment is the same as outpatients and can be used
alongside normal diet

Comments & Questions!!!!S