Proceedings of the WHO, UNICEF, and SCN Informal Consultation on Community-Based Management of Severe Malnutrition in Children

About 10 million children worldwide are estimated to suffer from severe malnutrition (defined by the presence of severe wasting, bipedal edema, or both), which greatly increases the risk of mortality. Severe malnutrition is an important cause of death in infants and young children, but one that is increasingly open to successful management. Prevention of severe, life-threatening malnutrition remains a priority, but even with expanded programs, a proportion of children will develop severe malnutrition and require treatment in the foreseeable future. Moreover, acute crises leading to high levels of malnutrition are likely to continue, and addressing the threats to survival under these conditions will continue to be a humanitarian concern. Effective interventions for the management of severe malnutrition with adequate coverage of affected populations could prevent hundreds of thousands of child deaths each year, thus contributing to the achievement of the Millennium Development Goals for the reduction of poverty and child mortality. Recently, new approaches to treatment have become available, which led to the meeting held by the World Health Organization (WHO) whose proceedings are published in this issue of the Food and Nutrition Bulletin. The capacity to treat large numbers of severely malnourished children is lacking in most countries, particularly the poorest, where the problems are the most extensive. Although facility-based (inpatient) treatment has proven effective in reducing case fatality rates, access to suitable health facilities is often limited, especially where it is most needed. This applies particularly to emergencies and is also true for nonemergencies in situations in which health resources are very limited. Furthermore, inpatient care requires the caretaker to stay in the health facility with the child for several weeks, which is often impractical and disruptive for the family. Recent evidence from field programs has shown that management of severe malnutrition at home (community-based management) can be very effective and achieve high levels of coverage in target populations. This approach is based on early detection and assessment of severely malnourished children in the community and home-based care of those without complications; those with complications (notably evidenced by loss of appetite) will still need facilitybased treatment. These procedures are considered to be effective for application both in emergencies and in nonemergencies where there is significant severe malnutrition. They may also have important potential for inclusion in broader health and nutrition programs—which include preventive measures— as a back-up when severe life-threatening malnutrition nonetheless occurs. The meeting aimed to review recent experience and evidence and to update global recommendations for the management of severe malnutrition as an essential intervention toward achieving the Millennium Development Goals for the reduction of poverty and child mortality. Drawing on the information presented in the five background papers, reviews of these papers, and presentations of additional data from research and programs, the participants in the consultation examined the implications of these new developments for the management of severe malnutrition. The consultation identified areas of consensus that can be translated into evidence-based guidelines, as well as knowledge gaps that should be addressed by research. Proceedings of the WHO, UNICEF, and SCN Informal Consultation on Community-Based Management of Severe Malnutrition in Children