Integrated Management of Acute Malnutrition

1. Integrated Management of Acute Malnutrition Session 1: Introduction and Course Orientation

2. Introduction of Trainees Participants will give their • Name • Agency/organisation • Working station • Experience in treating malnutrition (work done, where and for how long)

3. Expectations and concerns What are your expectations and concerns regarding training?

4. Workshop Etiquette Arrive on time – don’t keep others waiting Put mobile phone off or on silent mode One person to speak at a time Participation by all in discussions Fill in and drop off questions/ suggestions in the suggestion box Respect everyone’s questions and comments Training room is a non-smoking zone

5. Housekeeping/Logistics Tea breaks Prayer and lunch break Washrooms Allowances

6. Knowledge Pre-Test

7. Session 1: Training Objective To orient health workers on malnutrition in Zanzibar, the purpose of its management, and overview of the Zanzibar IMAM Guidelines - FOCUS OF THIS TRAINING IS ON ONE OF THE COMPONENTS; OUTPATIENT THERAPEUTIC CARE OF CHILDREN WITH SAM COMPONENT

8. Session 1: Learning objectives By the end of the session, participants should be able to • Explain the importance of managing acute malnutrition • Understand and describe the status of nutrition in Zanzibar • Be familiar with the contents of the Zanzibar IMAM AND OTC GUIDELINE

9. Session 1: Content • Malnutrition in Zanzibar • Purpose of managing acute malnutrition • Overview of the Zanzibar IMAM Guidelines • Contents of the training

10. Malnutrition in Zanzibar

11. Background Malnutrition is an important public health problem in Zanzibar, especially for children under five years. Malnutrition is responsible for one third of deaths in children under five years Severe acute malnutrition (SAM) is the deadliest form of malnutrition. Up to 50% of children with SAM will die if they do not receive correct treatment

12. Malnutrition in children <5 yr in Zanzibar

13. Malnutrition in Zanzibar • Prevalence of malnutrition Zanzibar has sharply declined in last decade • However, prevalence of acute malnutrition (wasting) is double that on the mainland (6.1 % vs 3%) • 5.4% children in Zanzibar have moderate acute malnutrition (MAM). This is about 8,345 children • 0.7% children in Zanzibar have severe acute malnutrition (SAM). This is about 1,080 children

14. Purpose of managing acute malnutrition There are two main objectives: • Prevent malnutrition through public health interventions and nutrition education • Treat acute malnutrition to prevent deaths and ill-health

15. Zanzibar Guidelineson Integrated Management of Acute Malnutrition

16. Zanzibar IMAM Guidelines • Guidelines have been developed to assist health workers in diagnosing, preventing and treating acute malnutrition. • Two versions of the guidelines are available: • FULL guidelines covering both inpatient and outpatient care, designed for PHCC, district hospitals and referral hospitals • SHORT guidelines covering outpatient care, designed for PHCU only (MAIN EMPHASIS OF THIS TRAINING)

17. Contents of the full guidelines Section 1: Introduction to the Guidelines Explains purpose of the guidelines, and how to use the guidelines. Section 2: Overview of malnutrition Explains the different categories and causes of malnutrition, definitions of malnutrition, and gives an overview of the integrated management of acute malnutrition.

18. Section 3: Community outreach & social mobiliz. Discusses how to plan and conduct community outreach and mobilization. Section 4: Screening, diagnosis and admission/ enrollment Discusses how children are screened, diagnosed and admitted/enrolled for the treatment of acute malnutrition. Section 5: Inpatient therapeutic care of severe acute malnutrition for children aged 6-59 months Provides guidelines on the management of SAM for children aged 6-59 months in the inpatient setting.

19. Section 6: Inpatient therapeutic care of acute malnutrition for children aged <6 months Provides guidelines on the management of acute malnutrition for infants aged <6 months in the inpatient setting. Section 7: Outpatient therapeutic care of severe acute malnutrition for children aged 6-59 months Provides guidelines on management of severe acute malnutrition in children aged 6-59 months in the outpatient setting.

20. Section 8: Management of MAM Provides guidelines on management of MAM Section 9. Forecasting, procurement & storage of supplies Discusses the forecasting, procurement and storage of supplies for the management of acute malnutrition. Section 10: Monitoring, evaluation & supervision Explains how to monitor and evaluate services, and how to provide supportive supervision.

21. Section 11: Coordination Outlines implementation arrangements for the guidelines, including institutions’ roles and responsibilities. Annexes Set of annexes providing tools for implementation of the guidelines. Some annexes are also provided as Job Aids.

22. Training Package on IMAM

23. Training package • Training package is based on the Guidelines. • Different trainees will be trained on different parts of the Guidelines • All trainees should have • A copy of the FULL or SHORT guidelines to refer to during training. • Training Schedule • Set of handouts

25. Training Schedule

26. Handouts1a: Definition of Terms1b: Abbreviation list

27. Summary

28. Summary • Malnutrition is a major public health problem in Tanzania • About 1000 children in Zanzibar have severe acute malnutrition and about 8000 have moderate acute malnutrition. • Guidelines and a training package have been developed to assist health service providers and their supervisors in managing acute malnutrition. • By the end of this workshop, participants will have the knowledge and skills to manage acute malnutrition at the inpatient level.