e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

Alternate Text All interventions

Management of infants under 6 months of age with severe acute malnutrition

Intervention | Last updated: 9 August 2023

In infants who are under 6 months of age, severe acute malnutrition is defined by a very low weight-for-length or the presence of bilateral pitting oedema. Severe acute malnutrition is increasingly being recognized in infants under 6 months of age and is often associated with higher mortality in young infants than in older infants and children.

In addition to causative factors such as low birth weight, persistent diarrhoea and chronic underlying diseases or disability, the development of severe acute malnutrition in infants under 6 months of age commonly reflects suboptimal feeding practices, especially breastfeeding practices.

There are important physiological differences between young infants and older children that may require modified management approaches or clinical interventions. Clinical signs of infection and hydration status may also be more difficult to identify and interpret in the younger infant. WHO has developed a set of recommendations for the identification and management of severe acute malnutrition in infants who are under 6 months of age.

WHO Recommendations

Infants who are under 6 months of age with severe acute malnutrition should receive the same general medical care as infants with severe acute malnutrition who are 6 months of age or older.

Feeding approaches for infants who are under 6 months of age with severe acute malnutrition should prioritize establishing, or re-establishing, effective exclusive breastfeeding by the mother or other caregiver.

Infants under 6 months of age can be discharged from all care when they are: i) breastfeeding effectively or feeding well with replacement feeds, ii) have adequate weight gain and iii) have a weight-for-length ≥–2 Z-scores of the WHO Child Growth Standards median.



Evidence

Systematic reviews used to develop the guidelines

The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review

Picot J, Hartwell D , Harris P, Mendes D, Clegg AJ, and Takeda A. Health Technology Assessment. 2012; Vol.16:No.19(for Guideline: Updates on the management of severe acute malnutrition in infants and children).

Inpatient treatment of severe acute malnutrition in infants aged 6 months

pdf, 1.19Mb Kerac M, Tehran I, Lelijveld N, Onyekpe I, Berkley J, Manary M. Geneva: World Health Organization; 2012.

Cost-effectiveness Learn More Alternate Text

Cost-effectiveness analyses

The analyses listed below were conducted to assess the overall cost-effectiveness of inpatient and/or outpatient management of SAM, of which the intervention listed on this webpage is a component. The analyses do not assess the cost-effectiveness of this specific intervention alone.

The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K. Health Policy Plan. 1998; 13(3):249-62.

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif A-M C, Nonvignon J. Health. 2014; 6: 886-899.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

Puett C, Sadler K, Alderman H, Coates J, Fiedler JL, Myatt M. Health Policy Plan. 2013; 28(4):386-99.

Cost-effectiveness of community-based management of acute malnutrition in Malawi

Wilford R, Golden K, Walker DG. Health Policy Plan. 2012; 27(2):127-37.

Costs, cost-effectiveness and financial sustainability of community-based management of acute malnutrition in northern Nigeria

Frankel S, Roland M, Makinen M. Washington DC: Results for Development Institute; 2015.

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Tekeste A, Wondafrash M, Azene G, Deribe K. Cost Eff Resour Alloc. 2012; 10:4.

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Goudet S, Jayaraman A, Chanani S, Osrin D, Devleesschauwer B, Bogin B, et al. PLoS One. 2018; 13(11):e0205688.

Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

Bachmann MO. Cost Eff Resour Alloc. 2009 Jan; 7:2.

Category 1 Intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

Learn More Alternate Text

Essential Nutrition Actions

This intervention is a component of managing children with SAM, which is an Essential Nutrition Action targeting the first 1000 days of life.

Learn More Alternate Text