Admission and discharge criteria for children 6 to 59 months of age with severe acute malnutrition in a resource-limited setting

IMCI: integrated management of childhood illness; MUAC: mid-upper arm circumference; SAM: severe acute malnutrition.

* Severe edema is defined as generalized edema including both feet, legs, hands, arms, and face. Moderate edema involves both feet plus lower legs, hands, or lower arms. Mild edema involves both feet only.

¶ Admit to hospital if the child is having a convulsion now or if there is a history of either more than 1 convulsion or a prolonged convulsion (>15 min).

Δ The decision to transfer a child from inpatient to outpatient care should be determined by the clinical condition and not on the basis of specific anthropometric outcomes, such as a specific MUAC or weight-for-length/height Z-score.

◊ The 2023 World Health Organization Guideline recommends both weight-for-height Z-score and MUAC as anthropometric criteria for discharge but recognizes that some children will gain a significant amount of weight during treatment and appear to have made significant clinical improvement while only achieving 1 of these anthropometric criteria (weight-for-height Z-score or MUAC). In that case, it is still reasonable to discharge them from care as recovered if they have completed the maximum duration of care that is used locally for the malnutrition treatment program (usually 12 to 16 weeks). Percentage weight gain and absolute weight gain should not be used as criteria for discharge.