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close this bookNutrition Guidelines (MSF, 1995, 191 p.)
close this folderPart III Selective feeding programmes
View the document1. Justification for selective programmes
View the document2. Criteria for admission and discharge to selective feeding programmes
View the document3. Screening and selection
View the document4.Treatment in a therapeutic feeding centre
View the document5. Treatment in supplementary feeding programmes
View the document6. Implementation and management of a feeding centre
View the document7. Registration and monitoring
View the document8. Evaluation of feeding programmes
View the document9. Food management

1. Justification for selective programmes

Proper treatment of a patient with severe Protein-Energy Malnutrition (PEM) is crucial in order to avoid death. A review of hospital treatment provided to cases with severe malnutrition demonstrated that 20 - 30% of malnourished patients die in the hospital and a further one-third die after having left the hospital (after discharge or drop-out).

Some children reach the hospital too late and die almost immediately upon arrival. However, the great majority of deaths occur after the first days of hospitalization (usually 60 -70% of deaths) and should be preventable. Home based treatment of children with severe P EM has also proved to be largely unsuccessful, with high mortality rates, high rates of non-compliance and slow recovery.

During food crises, health services risk becoming overwhelmed by large numbers of severely malnourished: a specialized nutrition rehabilitation unit or Therapeutic Feeding Centre (TFC), attached to a hospital or health centre has proven to be the most effective means of managing such situations.

Adequate treatment of severe PEM is an intensive task. A combination of good quality medical care and a specialized feeding protocol is required.

A TFC comprises of an intensive care unit, where medical complications are treated, and where nutritional treatment is started. While in the intensive care unit, the child will receive 8 - 10 meals per 24 hours, day and night. When the child has passed the critical phase, he will be transferred to the day-care unit, which is open 8 - 9 hours a day, and where the child will receive 4 - 6 meals and medical care.

However, it is not always possible to organize a TFC in this way. Security problems, lack of competent staff or large numbers of severely malnourished children may mean that it is only possible to open day-care centres. Under these conditions, even though the intensive care of a 24-hour unit is lacking, the impact on mortality of daycare centres alone may still justify running a Therapeutic Feeding Programme (TFP).

In addition, Supplementary Feeding Programmes (SFPs) may be required to prevent moderately malnourished children becoming severely malnourished (targeted SFP) and to reduce the further deterioration of the nutritional situation (blanket SFP).

The planning and implementation of TFPs and SFPs is a step-by-step process. Although every situation has its own characteristics and requires a specific tailormade approach, these guidelines attempt to help the reader in making decisions to design and implement different types of feeding programmes.