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Module 1

This document provides an overview of a training on the Philippine Integrated Management of Acute Malnutrition (PIMAM) program for regional and provincial participants. The objectives of the training are to train community health workers, health professionals, and local government leaders to identify, refer, provide rights-based care, counsel, and monitor children under 5 years of age with moderate acute malnutrition or severe acute malnutrition, with the goal of achieving zero cases. The training will cover modules on introducing PIMAM, the problem of childhood deaths due to undernutrition, the PIMAM program components, and the management of moderate and severe acute malnutrition using updated treatment protocols.

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roseannurak
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196 views

Module 1

This document provides an overview of a training on the Philippine Integrated Management of Acute Malnutrition (PIMAM) program for regional and provincial participants. The objectives of the training are to train community health workers, health professionals, and local government leaders to identify, refer, provide rights-based care, counsel, and monitor children under 5 years of age with moderate acute malnutrition or severe acute malnutrition, with the goal of achieving zero cases. The training will cover modules on introducing PIMAM, the problem of childhood deaths due to undernutrition, the PIMAM program components, and the management of moderate and severe acute malnutrition using updated treatment protocols.

Uploaded by

roseannurak
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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ZERO SAM & MAM

Training of Trainers on the


Philippine Integrated Management
of Acute Malnutrition (PIMAM) for
Children under Five Years of Age
Regional/Provincial Level Participants
October 2020
Welcome Remarks
Name
Designation
Office/Agency
House Rules
• Participants other than the speaker and the host are expected to give
their full attention while the presentation is on-going.
• Time for open forum will be allotted at the end of all presentations to
address other questions received from the participants.
Objectives of the Training
• Train community health workers, health professionals and LGU leaders
to:
⮚ Identify
⮚ Refer
⮚ provide rights-based care
⮚ counsel and
⮚ monitor children under 5 and their families
towards Zero SAM & MAM

• Practice the delivery of selected modules of the PIMAM Training


Course
DOH Consultant
[insert names]

UNICEF Consultant
[insert names]
WFP Consultant
[insert names]

KMI Consultants
[insert names]
Secretariat/Admin. Officers
[insert names]
MODULE 1
Introduction to Philippine Integrated
Management of Acute Malnutrition

Name
Designation
Office/Agency
Learning Objectives
• At the end of the session, you will be able to:
• Explain what malnutrition is and its related concepts
• Discuss the problem of childhood deaths due to undernutrition - moderate
acute malnutrition (MAM) and severe acute malnutrition (SAM)
• Describe the Global and PPAN Goals on Acute Malnutrition
• Describe the Philippine Integrated Management of Acute Malnutrition
(PIMAM) program
• Explain the four guiding principles of PIMAM
• Explain the four (4) components of the integrated management of severe
acute malnutrition within the PIMAM
Basic Principles

• Each child has the right to food, health


and care to enable optimum potential
• Lack of food, health and care are risk
factors for malnutrition
• Malnutrition is strongly linked with
death
http://1000days.unicef.ph/
Malnutrition
• Body’s dietary or food intake not in balance with nutritional
needs failing to maintain healthy tissues and organ function
• Results in either:
OVERNUTRITION UNDERNUTRITION

http://www.huffingtonpost.co.uk/2015/03/02/obese-baby-india-six-year-old_n_6785324.html https://www.unicef.org/philippines/reallives_19053.html
Causes of Undernutrition
Immediate Causes Individual Inadequate/excess food
intake
Disease
Underlying Causes Community Poor access to food
Obesogenic Food
Environment
Bad care practices
Poor water, sanitation
and health services
Basic Causes Societal Lack of capital – human,
financial, physical, social

Black et al, 2008, The Lancet


Types of Undernutrition
1. Acute Malnutrition
• Sudden wasting and/or edema due to:
▪ insufficient food intake
▪ infection
▪ inappropriate childcare practices
• Diagnosed when:
▪ inadequate weight for height (WFH), weight
for age AND/OR
▪ muscle wasting AND/OR
▪ bilateral pitting edema
Low Weight for Height
Philippine Department of Health.
National Guidelines on the Management of Severe Acute Malnutrition for Children under Five Years Manual of Operations. 2015.
Acute Malnutrition (a.k.a wasting)

Moderate Acute Malnutrition (MAM) Severe Acute Malnutrition (SAM)


or Moderate Wasting or Severe Wasting
Weight-for-Height Z-score -3SD to <-2 SD Weight-for-Height Z-score <-3 SD
and/or MUAC 11.5cm to 12.4cm and/or MUAC < 11.5cm
and no bilateral pitting edema and/or with bilateral pitting edema

Global Acute Malnutrition (GAM) is the sum of the


prevalence of SAM plus MAM at population level.
Severe Acute Malnutrition – encompasses
wasting and bilateral edema
MARASMUS KWASHIORKOR Marasmus:
Refers to severe wasting

Kwashiorkor:
Refers to nutritional edema

These can kill.


Children with SAM are 9-12
times more likely to die than well
nourished kids.
Moderate Acute Malnutrition – encompasse
wasting but no bilateral edema

Moderate wasting (Thin)

No nutritional edema

This can also kill.


Children with MAM are 3-4 times
more likely to die than well
nourished kids.
Comparing the Prevalence of Malnutrition
Philippines
UNDERWEIGHT 19 out of 100 children
STUNTING 3 out of 10 children
WASTING 6 out of 100 children
OVERWEIGHT AND 4 out of 100 children
OBESITY

Prevalence of Malnutrition among Children under 5 years (ENNS, 2018)

WASTING
IN PHILIPPINES
Case Fatality Rate

Although the risk of dying in children


with MAM is 3-4X and that of SAM is
Severe Acute
Malnutrition 9-12X higher than well-nourished
4.4%
(SAM) children,

the absolute number of death in


children with MAM is higher because
Moderate Acute
Malnutrition 10.2% of the higher number of children with
(MAM) MAM.

*Source: Black, et al., 2008


Types of Undernutrition

2. Chronic Malnutrition or Stunting 3. Micronutrient Malnutrition

Low Height for Age


Other Types of Undernutrition

4. Fetal Growth Restriction

5. Suboptimal breastfeeding

Photo from http://www.zofranlawsuitguide.com/

1
Black RE et al. The Lancet Nutrition Series Part 1. 2013.
The 3 children are of the same age
Wasted Stunted

Same height Same weight

Weight for age Normal Low Low


Height for age Normal Normal Low
Weight for Height Normal Low Normal
For those who survive,

• Lifetime of ill-health
• Unrealized human potential
• Malnutrition spans
generations
Life course and inter-generational
effects of malnutrition

Cycle of
Undernutrition
This is how our undernourished Filipino children look:
Both are 2 years old
Naturally Short?
PANDAK??

Our kids
can really
NOT be.

Photo credit: Rosalia Bataclan, MD


The Sustainable Development Goals
(SDGs) 2016-2030
Global Nutrition Report 2015

• Sustainable
Development Goals
(SDGs) – 2 and 3
• Commit to rapid
reduction of
malnutrition by
2025
PPAN 2017-2022 TARGET for Wasting
To reach the goal…
DOH Strategic Framework for Comprehensive Nutrition Implementation Plan
2014-2025
First 1000 days
Management of Moderate and Severe
Acute Malnutrition – Why?

• Children with SAM are 9 -12 times


more likely to die than those who are
well nourished.

• Children with MAM are 3 - 4 times


more likely to die than those who are
well nourished.

• Recognized and treated early, it can be


reversed with proper food, nutrition
and care.
Philippine Integrated Management
of Malnutrition (PIMAM)
Component of the wider Strategic Framework 2014-2025
Rationale:
• In hospital treatment in “MalWards”
▪ Outdated protocols
▪ Overcrowding in the hospitals
▪ Cross-infection
▪ High default rates - mothers wanted to go home to take care of other
children
▪ Heavy work load of hospital staff
• Intermittent and ineffective supplementary feeding programs
• Malnutrition is a reality in both normal times and emergencies
Treat Children with SAM with appropriate
Care using UP-TO-DATE treatment protocols

• SAM affects the child’s normal physiological functions


• SAM children cannot be medically treated like other sick children
• Malnutrition alters the SAM child’s physiology
• Old treatment protocol can do more harm than good
• SAM children require specialized treatment
Treat Children with MAM with appropriate Care
using UP-TO-DATE treatment protocols

• treatment of MAM will prevent deterioration of MAM to SAM

• if there are no programs to address MAM especially during


emergencies, SAM cases tend to increase
PIMAM
(Philippine Integrated Management of Acute Malnutrition)

• PIMAM, or management of MAM


and SAM, is part of routine health
and nutrition services at all levels

• Involves and relies on a strong


community component
PIMAM Four Guiding Principles
1. 1. Maximum Coverage and Access

2. 2. Timeliness

3. 3. Appropriate Care

4. 4. Care: When and Where it is needed


The Innovation in Integrated Management

Targeted
Components of PIMAM
1. Management of SAM Outpatient Therapeutic Care (OTC)
without complications

2. Management of SAM with Inpatient Therapeutic Care (ITC)


complications

3. Management of MAM Targeted Supplementary Feeding Program


(TSFP)

4. Community Outreach Community Mobilization


DOH A.O. No. 2015-0055
National Guidelines on the Management of
Acute Malnutrition for Children under 5
years.
Standardized protocols

Emphasis on linkages and referrals, supply networks,


indicators for monitoring, and importance of PIMAM
in emergency settings

Describes our roles

Four components of integrated management of


Moderate and Severe Acute Malnutrition
Summary

• Undernutrition is a neglected condition

• More Filipino children under the age of 5 years are affected

• Cause for 50% of all childhood deaths but unrecognized and untreated

• SAM children risk of death is 9-12 times higher than a well nourished child

• MAM children risk of death is 3-4 times higher than a well nourished child

• Nutrition sensitive and specific interventions now combat malnutrition

• PIMAM manages malnutrition in normal times and emergencies


Are you ready to learn and do your role?

Our Goal is
ZERO SAM
and MAM

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