PIMAM

PHILIPPINE INTEGRATED MANAGEMENT ON

ACUTE MALNUTRITION
 national guideline for the management of Moderate Acute
Malnutrition (MAM) and Severe Acute Malnutrition (SAM)
among children under five years of age.
The guidelines are consistent with the “All for Health
towards Health for All” Agenda of the DOH. Further, they
support the implementation of the Philippine Plan of Action
for Nutrition (PPAN) 2017-2022, which aims to decrease
acute malnutrition, reduce child mortality and improve the
survival of children under 5 years.
“Children with Moderate Acute Malnutrition have a higher
risk of mortality associated with nutrition-related deaths. If
they do not receive adequate support and equitable
attention, severe acute malnutrition such as extreme
wasting or stunting may happen, which are both life-
threatening conditions
 ACUTE MALNUTRITION IN THE PHILIPPINES

7.1%

5.2%
NEARLY 1 MILLION
OVER 700,000 UNDER 5 FILIPINO
CHILDREN ARE
WASTED
1.9%
NEARLY 200,000

MAM
SAM
 PIMAM
According to a recent National Nutrition
Survey by the Food and Nutrition
Research Institute (FNRI), about one
million Filipino children suffer from
acute malnutrition.

The ultimate goal is to significantly lower, if

not zero out, the rate of acute malnutrition in
the Philippines
 Malnutrition
• Body’s dietary or food intake not in balance with
nutritional needs failing to maintain healthy tissues and
organ function • Results in either:

OVERNOURISHED UNDERNOURISHED

This Photo by Unknown Author is licensed under CC BY-

SA-NC
Causes of Undernutrition
Immediate Causes-- Individual
Inadequate food intake  Disease
Underlying Causes -- Community
Poor access to food, Bad care
practices, Poor water, sanitation and
health services
Basic Causes --Societal
Lack of capital – human, financial,
physical
 WEIGHT LOSS,
GROWTH
FALTERING,
IMMUNITY
LOWERED,
MUCUSAL
DAMAGE

INTERACTION
INADEQUATE OF INCIDENCE OF
DIETARY
INTAKE MALNUTRITION DISEASE
AND DISEASE

APPETITE LOSS
NUTRIENT LOSS
MALABSORPTIO
N
ALTERED
METABOLISM
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
2. Chronic Malnutrition or Stunting

“Too short for one’s age” • Inadequate

height/length for age (HFA/LFA) • In the
first 1000 days after conception • Stunting
before the age of 2 years old: ▪ poor
cognitive and educational outcomes ▪
mental and physical deficits are
potentially irreversible beyond two years
First 1000 days
3. Micronutrient Malnutrition
• Micronutrients - Nutrients needed
in small quantities.
• Deficiencies lead to malnutrition
and disease
• Common deficiencies: Vitamin A,
Iron and Iodine
Other Types of Undernutrition

4. Fetal Growth Restriction

Abnormal fetal growth • Low birth
weight (LBW) babies (< 2.5 kg) •
Poor maternal nutrition • 15 times
higher risk of death in newborn
period vs. normal weight babies

5. Suboptimal breastfeeding
Breastfeeding NOT up to standard •
800,000 child deaths
Acute Malnutrition (a.k.a
wasting)
Moderate Acute Malnutrition (MAM) or
Moderate Wasting Weight-for-Height Z-score -3SD
to <-2 SD and/or MUAC 11.5cm to 12.4cm and no
bilateral pitting edema
Severe Acute Malnutrition (SAM) or Severe
Wasting Weight-for-Height Z-score <-3 SD and/or
MUAC < 11.5cm 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: 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 –
encompasses wasting but no bilateral
edema
This can also kill. Children with MAM are 3-
4 times more likely to die than well
nourished kids.
 CASE FATALITY RATE
Severe Acute Malnutrition (SAM) 4.4%

Moderate Acute Malnutrition (MAM) 10.2%

Although the risk of dying in children with

MAM is 3-4X and that of SAM is 9-12X
higher than well-nourished children,
the absolute number of death in children
with MAM is higher because of the higher
number of children with MAM.
Why focus on undernutrition? It Kills!
IT CAUSES 45% OF CHILDHOOD DEATHS
 NORMAL MAM SAM

WFL/H -2 to +2 < -2 to -3 < -3

Z-SCORE
Measuring the Left Mid Upper Arm Circumference
(MUAC)

• Measured in children 6 to 59 months of age • A simple

measure of muscle wasting • An independent measure of
SAM • Strongly predicts risk of dying from SAM
 ACUTE MALNUTRITION

SAM patients
SAM patients with
w/o MAM patients
complications
complications

In patient care Out patient care Targeted supplementary

feeding