Submission ID 131908
| Issue/Objective | Severe Acute Malnutrition (SAM) remains a leading contributor to under-five morbidity and mortality in Western Kenya. Kenya's 2009 National Guideline for the Integrated Management of Acute Malnutrition (IMAM) provides the clinical reference standard, but community-based organisations outside formal health facilities face barriers to applying it: shortages of therapeutic formula and commercial mineral and vitamin premixes, limited capacities and inconsistent referral pathways. The Safe Water & AIDS Project (SWAP), operating in Kisumu County since 2007, encountered this gap when its team identified a young child with cerebral palsy requiring urgent nutritional support. This objective of this work was to develop an operational SAM guideline usable by non-specialist community-level staff. |
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| Methodology/Approach | We developed a simplified guideline for children from birth to five years, anchored in Kenya's IMAM framework, across three components: (i) a stepwise triage procedure combining Mid-Upper Arm Circumference, weight-for-height Z-scores, and oedema assessment, with visual aids ; (ii) a therapeutic recipe approximating Phase 1 F-75 macronutrient composition; and (iii) a Mineral and Vitamin Mix Substitute built from locally procurable foods - banana, avocado, kale, sweet potato, egg, iodised salt - with micronutrient-by-micronutrient alternatives to accommodate seasonal and household variability. Development occurred through 2025. |
| Results | Three design tensions emerged. First, protocol fidelity versus feasibility: input substitution required accepting approximation rather than equivalence. Second, flexibility versus precision: avoiding fixed quantities preserved usability across contexts but placed interpretive burden on frontline users. Third, scope boundaries: the guideline is an adjunct for identification, initial response, and referral, not a substitute for in-patient care. The cerebral palsy index case further surfaced a gap: children with disabilities may require caregiver-mediated feeding approaches absent from general SAM guidance. |
| Discussion/Conclusion | National IMAM protocols exist across sub-Saharan Africa, but reach to community-level actors is uneven. This case illustrates closing that gap by anchoring in existing national standards rather than creating parallel ones, adapting inputs to what is locally procurable, and writing for frontline users. The guideline has not yet been formally evaluated; next steps include structured pilot use, training, and outcome tracking. Sharing the design rationale invites methodological feedback from peers adapting protocols in comparable community-based settings, a practical expression of equity-in-action. |
| Presenters and Affiliations | Caroline Raymond Centre de recherche en santé publique Jared Oremo Safe Water for AIDS Project Caroline Raymond Centre de recherche en santé publique |
