Interventions for Protein-energy malnutrition

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education of pregnant women on infant and child feeding
Primary Care
Education of pregnant women on infant and child feeding
Referral Facility: General
Education of pregnant women on infant and child feeding
Referral Facility: Specialist
Education of pregnant women on infant and child feeding

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on appropriate and timely complementary feeding and healthy infant and young child nutrition Education on use of safe water and good compound practices	Examine children during home visits for signs of protein energy malnutrition and advise parents accordingly Education of proprietors of pre-school facilities on adding provision of one healthy meal to children in their facilities	Recognition of protein energy malnutrition signs and symptoms Community based MUAC and bilateral oedema screening	Community-based therapeutic feeding Immediate transfer of sever cases to a higher-level health care facility	Home based nutritional rehabilitation	Emotional and social support for the child and family
Primary Care
Health education on feeding, good hygiene practices and regular growth monitoring	Group and focused counselling of mothers and carers on MIYCN- Early initiation of breastfeeding, appropriate and timely complementary feeding, food demonstrations. Improved sanitation and hygiene practices	History Physical examination Mid-upper arm circumference (MUAC) Weight-for-height z-score (WHZ) Presence or absence of oedema	F-75 and F-100 therapeutic milks Ready-to-use therapeutic food (RUTF) Vitamin A supplementation Folic acid Deworming Antibiotics Measles vaccination Antimalarial	Nutritional rehabilitation	Emotional and social support for the child and family
Referral Facility: General
Health education on timely complementary feeding and good hygiene practices		History Physical examination Mid-upper arm circumference (MUAC) Weight-for-height z-score (WHZ) Presence or absence of oedema	F-75 and F-100 therapeutic milks Ready-to-use therapeutic food (RUTF) Vitamin A supplementation Folic acid Deworming Antibiotics Measles vaccination Antimalarial Blood transfusion Manage hypothermia Manage hypoglycaemia Mange electrolyte imbalances	Nutritional rehabilitation	Emotional and social support for the child and family
Referral Facility: Specialist
Health education on timely complementary feeding and good hygiene practices		History Physical examination Mid-upper arm circumference (MUAC) Weight-for-height z-score (WHZ) Presence or absence of oedema	Educate mothers on feeding of children through provision of practical examples using local foods Treat existing infections in severe cases Provide macronutrients for severe cases by appropriate means (orally, feeding tube, nasogastric tube, gastrostomy tube) Provide lactose free liquid oral food supplements if solid food cannot be adequately ingested Provide children with multivitamin supplement Treat mild to moderate cases with balanced oral diet Correct fluid and electrolyte imbalances for severe cases Provide lactose free liquid oral food supplements if solid food cannot be adequately ingested Provide children with multivitamin supplement	Nutritional rehabilitation	Emotional and social support for the child and family

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Education of families on healthy nutrition for the elderly	Education of families on healthy nutrition for the elderly		Follow up cases of protein energy malnutrition being managed at home to ensure compliance with treatment and advice
Primary Care
			Educate caregivers on feeding of the elderly through provision of practical examples using local foods Refer severe cases of protein energy malnutrition to hospital for further management Treat mild to moderate cases with balanced oral diet Provide lactose free liquid oral food supplements if solid food cannot be adequately ingested Provide with multivitamin supplement Provide treatment to correct other specific deficiencies Treat any underlying conditions
Referral Facility: General
			Educate caregivers on feeding of the elderly through provision of practical examples using local foods Provide with multivitamin supplement Provide treatment to correct other specific deficiencies Refer severe cases of protein energy malnutrition to hospital for further management Treat mild to moderate cases with balanced oral diet Provide lactose free liquid oral food supplements if solid food cannot be adequately ingested Provide with multivitamin supplement Treat any underlying conditions
Referral Facility: Specialist
			Educate caregivers on feeding of the elderly through provision of practical examples using local foods Provide with multivitamin supplement Provide treatment to correct other specific deficiencies Refer severe cases of protein energy malnutrition to hospital for further management Treat mild to moderate cases with balanced oral diet Provide lactose free liquid oral food supplements if solid food cannot be adequately ingested Provide with multivitamin supplement Treat any underlying conditions

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Community awareness on appropriate and timely complementary feeding and healthy infant and young child nutrition Education on use of safe water and good compound practices	Guidance on appropriate and timely complementary feeding, food demonstrations. Vitamin A supplementation; * Hygiene, sanitation and deworming for preschool children;	Recognition of protein energy malnutrition signs and symptoms Community based MUAC and bilateral oedema screening	Refer children identified with MUAC<12.5cm to next level Immediate transfer of sever cases to a higher-level health care facility
Primary Care
Health education on timely complementary feeding and good hygiene practices	Group and focused counselling of mothers and carers on MIYCN Guidance on appropriate and timely complementary feeding, food demonstrations Improved sanitation and hygiene practices Growth monitoring and promotion	History Physical examination Mid-upper arm circumference (MUAC) Weight-for-height z-score (WHZ) Presence or absence of oedema	F-75 and F-100 therapeutic milks Ready-to-use therapeutic food (RUTF) Vitamin A supplementation Folic acid Deworming Antibiotics Measles vaccination Antimalarial
Referral Facility: General
Health education on timely complementary feeding and good hygiene practices		History Physical examination Mid-upper arm circumference (MUAC) Weight-for-height z-score (WHZ) Presence or absence of oedema	F-75 and F-100 therapeutic milks Ready-to-use therapeutic food (RUTF) Vitamin A supplementation Folic acid Deworming Antibiotics Measles vaccination Antimalarial Local foods for complementary feeding and nutrition
Referral Facility: Specialist
Health education on timely complementary feeding and good hygiene practices		History Physical examination Mid-upper arm circumference (MUAC) Weight-for-height z-score (WHZ) Presence or absence of oedema	F-75 and F-100 therapeutic milks Ready-to-use therapeutic food (RUTF) Vitamin A supplementation Folic acid Deworming Antibiotics Measles vaccination Antimalarial Local foods for complementary feeding and nutrition