Management of Moderate Acute
Malnutrition (MAM) and Severe Acute
Malnutrition (SAM)53
As mentioned earlier, malnutrition is the single largest
cause of child mortality, responsible for an estimated 35
percent of childhood deaths.54, 55 Child survival efforts in
developing countries have focused disproportionately on
managing infectious diseases rather than eliminating malnutrition.56 While prevention of maternal and child malnutrition is extremely important, as discussed in the previous
sections, early treatment of children with moderate (MAM)
or severe (SAM) acute malnutrition is also essential. MAM
is defined as weight for height between two and three standard deviations below the median WHO growth standards.
SAM57 is defined by either a very low weight for height (more
than three standard deviations below the median), visible severe wasting, or nutritional edema (an observable swelling in
certain parts of the body).
Children suffering from chronic protein-energy malnutrition become “stunted”—shorter than they should be for their
age. In developing countries, 32 percent of children under
five years old are stunted. “Wasting” occurs when children
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maternal and child health services as well as community
services that target women should incorporate support for
optimal infant and young child feeding.
The Baby Friendly Community Initiative is a cost-effective effort49 to help ensure that all maternity wards, whether
free-standing or in a hospital, become centers of breastfeeding support.50 The initiative can be integrated into health
services to offer 10 easy steps for successful breastfeeding
that promote child growth and maternal nutrition and reduce morbidity. It emphasizes proper nutrition using locally
available high-nutrient foods, active feeding especially when
a child is ill, an