IMCI Malnutrition and Anemia

• Kwashiorkor


  • Edema of both food
• Severe Malnutrition


  • Less than 115mm (Mid upper arm circumference)
• 1 cm= 10mm


  Red Zone: Acutely Malnourished

  Yellow Zone: Moderately Nourished

  Green Zone: Properly nourished
• Different types of undernutrition

  • Normal
  • Wasting (Low weight for height)
  • Stunting (Low height for age)
  • underweight (Low weight for age)
• Marasmus


  • severe muscle wasting
  • folds of skin
  • buggy pants
• RUTF


  Ready to use therapeutic food
• Classify Nutritional Status

  1. Complicated Severe Acute Malnutrition
  2. Uncomplicated severe malnutrition
  3. Moderate Acute Malnutrition
  4. No Acute Malnutrition
• Complicated Severe Acute Malnutrition

  • Edema both feet
  • WFH/L- less than 3z score
  • MUAC less than 115mm
• treatment (complicated severe acute malnutrition)

  • 1st dose antibiotic
  • prevent low blood sugar
  • keep child warm
  • refer urgently
• Hypoglycemia


  low blood sugar
• Treatment hypoglycemia


  • breastfeed
  • sugar water (20gm sugar+ 200ml water)
  • 50 ml of milk or sugar water thru NGT
  • give D10 IV (5ml/kg)
• Uncomplicated Severe Acute Malnutrition

  • WFH/L - 3z score
  • MUAC less than 115 mm
  • able to finish ready to use therapeutic food
• Treatment (uncomplicated severe acute malnutrition)

  • give oral antibiotic for 5 days
  • give RUTF for child aged 6 months or more
• Moderate Acute Malnutrition


  • WFH/L between -3 and -2 z scores
  • MUAC 115 up to 125 mm
• no acute malnutrition


  • WFH/L -2 z scores or more
  • MUAC 125 mm or more"
• Green (normal)


  more than 12.5 cm
• Yellow (Moderate Acute Malnutrition)

  11.5- 12.4 cm
• SAM (Severe Acute Malnutrition)

  less than 11.5cm
• Assess, Clarify, Treat- Anemia Classification

  1. Severe Anemia
  2. Anemia
  3. No Anemia
• Anemia


  • Severe: Palmar Pallor (All white)
  • Anemia: Some Palmar Pallor (Pink and white)
  • No Anemia: No palmar pallor
• Anemia (treatment)


  • Give Iron 14 days
  • give Mebendazole if 1 yr or older and not had dose in previous 6 months