CHANCES BMI 13 bilateral pitting oedema (Beattie kg/m2, model These are suggested grade 3 or worse) when applied to starting points and unable to stand data from will require Ferro-Luzzi and apparent dehydration consideration of James* additional Also admit if famine oedema (Beattie It is considered factors. alone, by clinician grade 3 or worse) as severe assessment undernutrition Recommends Moderate undernutrition and is development of Admit into adult SFC if: associated with specific cut-off MUAC 161 - 185 and no relevant risk of mortality points to account for signs or few social criteria via changing screening for: redistribution of fat during ageing. access to food (quantity, quality) distance from centre Questions whether presence/absence of carers there is also a need dependents for ethnic differences cooking utensils to be investigated. shelter Borrel, 2001 > 60 Entry into selective feeding Based on data Formed the basis for programmes: from Nilotic UNHCR/WFP 2011 No admission: > 185 Normal populations recommendations, see Table 11 below. (unless famine oedema present, refer to clinician) SFC: 160 - 185 MAM TFC: < 160 SAM Entry into Community Support Programme CSP: > 185 High nutritional risk Applies to If one or more social criteria but no emergency situations anthropometric or clinical criteria, and famines. enter into CSP with the purpose of preventing further deterioration in Use in nutritional status Burundi/Congo failed to confirm its usefulness as a diagnostic tool Not yet been validated in other populations Grellety (ACF), SAM < 200 Figures are Personal 2001 MAM 200 - 210 between WHO communication 1995/ Ismail based on experience and Manandhar in Rwanda, not 1999/Collins et research-based al 2000 20 50 < 210 thin, select for further These are not meant – 2006 (weight loss, physical as admission criteria evaluation or criteria for strength and clinical signs) 50+ malnutrition < 180 select for evaluation(weight loss, physical strength and clinical signs) * based on James, Mascie-Taylor, Norgan, Bistriaw, Shetty & Ferro-Luzzi, 1994; Collins, 1996
CHANCES model bilateral pitting oedema (Beattie grade 3 or worse) unable to stand apparent dehydration Also admit if famine oedema (Beattie grade 3 or worse) alone, by clinician assessment Moderate undernutrition Admit into adult SFC if: MUAC 161 - 185 and no relevant signs or few social criteria via screening for: access to food (quantity, quality) distance from centre presence/absence of carers dependents cooking utensils shelter BMI 13 kg/m2, when applied to data from Ferro-Luzzi and James* It is considered as severe undernutrition and is associated with risk of mortality These are suggested starting points and will require consideration of additional factors. Recommends development of specific cut-off points to account for changing redistribution of fat during ageing. Questions whether there is also a need for ethnic differences to be investigated. Borrel, 2001 > 60 Entry into selective feeding programmes: No admission: > 185 Normal (unless famine oedema present, refer to clinician) SFC: 160 - 185 MAM TFC: < 160 SAM Entry into Community Support Programme CSP: > 185 High nutritional risk If one or more social criteria but no anthropometric or clinical criteria, enter into CSP with the purpose of preventing further deterioration in nutritional status Based on data from Nilotic populations Formed the basis for UNHCR/WFP 2011 recommendations, see Table 11 below. Applies to emergency situations and famines. Use in Burundi/Congo failed to confirm its usefulness as a diagnostic tool Not yet been validated in other populations Grellety (ACF), 2001 SAM < 200 MAM 200 - 210 Figures are between WHO 1995/ Ismail and Manandhar 1999/Collins et al 2000 Personal communication based on experience in Rwanda, not research-based 2006 20 – 50 50+ < 210 thin, select for further evaluation (weight loss, physical strength and clinical signs) < 180 select for evaluation(weight loss, physical strength and clinical signs) These are not meant as admission criteria or criteria for malnutrition * based on James, Mascie-Taylor, Norgan, Bistriaw, Shetty & Ferro-Luzzi, 1994; Collins, 1996
HTP-module-23-technical-notes.docx