IMAM TRAINING

Somalia National Guidelines

2020
PRESENTATION, EXPECTATIONS
and
1 question on IMAM!

Baidoa, 24-25-26 May 2021

MAY THE BEST WIN!
I.M.A.M. QUIZZ

THE CORE COMPONENTS IMAM
THE PRINCIPLE OF IMAM
ADMISSION CRITERIA OTP
CHILDREN UNDER 5 YEARS OLD
DISCHARGE CRITERIA TSFP
CHILDREN UNDER 5 YEARS OLD
THERAPEUTIC FOOD FOR
SEVERE ACUTE MALNUTRITION
ADMISSION CRITERIA TSFP FOR PLW
CORE ACTIVTIES FOR THE
COMMUNITY COMPONENT
1. Community Mobilization
2. TSFP
3. OTP
4. Stabilization Center
1. Maximum access and coverage
2. Timeliness
3. Appropriate medical and nutritional care
4. Care as long as needed
1. MUAC < 115 mm
2. W/H z-score <-3
3. Oedema bilateral pitting +/++
WITH Pass appetite test and NO medical complications
1. MUAC > =125 mm for 2 consecutives visits
2. W/H >= 1.5 Z-score for 2 consecutive visits
3. Defaulter : Absent for two consecutives visits
4. Dead : Died during time registered in TSFP
5. Non-cured : Has not reached the discharge criteria within 4 months
6. Referral to OTP : Has reached the SAM criteira
7. Transfer to another TSFP
1. MILK F75
2. MILK F100
3. PLUMPYNUT/eeZeePastNUT
4. BP100
1. Pregnant women (from the second trimester) WITH MUAC < 210 mm
2. Lactating women whose child is <6months WITH MUAC < 210 mm
1. Sensitize communities on acute malnutrition
2. Make treatment of acute malnutrition understandable
3. Promote community case-finding and referral
4. Conduct follow-up home visits for problem cases
 NUTRITIONAL STATUS

According to the World Health Organization (WHO),

“nutritional status” is the balance between food intake
and the body's needs. To meet their dietary needs and
stay healthy, people require food in sufficient quantity
and of adequate quality.
 Acute malnutrition type and classification

Undernutrition: which includes stunting, wasting,

underweight and micronutrient deficiencies or
insufficiencies (a lack of important vitamins and
minerals)

Overweight: obesity and diet related to non

communicable diseases (such as heart disease, stroke,
diabetes and cancer)

The term malnutrition always makes reference to

undernutrition, and more particularly to the
syndrome called Acute Malnutrition.
Acute malnutrition type and classification
Type of acute malnutrition
Malnutrition

Over-Nutrition Under-Nutrition

Stunting, wasting
Obesity
Underweight,
Micronutrient
deficiency
 What is Undernutrition?
• A consequence of a deficiency in nutrients in the
body
• Types of undernutrition?
‐ Acute malnutrition (wasting and bilateral pitting
oedema)
‐ Stunting
‐ Underweight (combined measurement of
stunting and wasting)
‐ Micronutrient deficiencies
• Why focus on acute malnutrition?
 Undernutrition and Child Mortality

Pe rinatal &
• 52.5% of child mortality
Ne wborn is associated with
22%
underweight

• Severe wasting is an
Pne umonia important cause of these
20%
Malnutrition deaths (it is difficult to
All othe r
52.5%
caus e s
estimate)
29%

• Proportion associated
Malaria with acute malnutrition
8%
often grows dramatically
Me as le s
5% Diarrhe a
HIV/ AIDS
4%
in emergency contexts
12%

Caulfied, LE, M de Onis, M Blossner, and R Black, 2004

 Acute malnutrition type and classification

Classification of acute malnutrition:

Moderate acute malnutrition (MAM)

Severe acute malnutrition (SAM):

- Marasmus
- Kwashiorkor
FOLLOW THE GROWTH OF THE CHILD
International standards for growth (WHO 2006) http://www.who.int/childgrowth/en/

 WHO: “Multicentre Growth Reference Study

(MGRS)” took place between 1997 and 2003
to make new growth curve to follow infants and
young children around the world.

 Growth and development of around 8500

children from different countries and ethnic
groups (Brazil, Ghana, India, Norway, Oman
& USA). These children were breastfed.

 We use 1 international standard reflecting

the best growth for all healthy children from
birth to the age of 19 years old.
Expressing Indices: Z-Score
ET = 1
WHO Reference Population
 MEDIAN
FOLLOW
THE
GROWTH Low weight for length
OF THE
CHILD
Very low weight for
length
Example: WHO Z-score Table
Example: WHO Z-score Table
 Causes of Malnutrition

The UNICEF conceptual framework of undernutrition is shown. Source: UNICEF. Improving Child Nutrition: The achievable imperative for
global progress. United Nations Children’s Fund; 2013
 Exercise
Prepare a cause of malnutrition tree for each sub-delegation
(30 minutes):
 Basic Causes
Regional and national level, where strategies and policies that
affect the allocation of resources influence what happens at
community level. Example of resources;

Human
Economic
Political and
Cultural

Geographical isolation and lack of access to markets due to poor

infrastructure can have a huge negative impact on food security
 Underlying Causes
Food: Limited access or availability of food

Health: Limited access to adequate health services and/or

inadequate environmental health conditions

Care: Inadequate social and care environment in the household

and local community
 Immediate causes
Lack of food intake and disease create a vicious cycle in which disease and
malnutrition exacerbate each other i.e. the Malnutrition-Infection Complex.

Infection Malnutrition

Lack of food intake and disease must both be addressed to support

recovery from malnutrition.
Spiral of infection and
malnutrition
Infections impair nutritional status by several
routes
Reduced food intake
 poor appetite
 mother/carer may withhold food

Increased utilization by the body

 energy and nutrients

Losses during diarrhoea

 protein, zinc
 potassium, magnesium
THANK YOU FOR YOUR
ATTENTION