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
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