How MSF teams treat malnourished children

Children found to be less than 70% of the expected weight for their height are defined as severely malnourished. MSF teams admit them to a therapeutic feeding centre, where they receive intensive care. First of all, any infections are treated - the commonest being pneumonia, diarrhoea and malaria. As the children are usually dehyrated (lacking in fluids) they are given oral rehydration solution. At the same time gentle re-feeding is commenced. MSF teams use a standard recipe to make up high-energy milk. This is a blend of milk, oil and sugar. It contains high numbers of calories in a small volume of food, which is what malnourished children need. In the first week they must be fed up to 12 times per 24 hours, and the feeding centres are staffed day and night. Because these children are at such high risk of death they are checked each day by an MSF doctor or nurse for life-threatening infections. They are also immunised against measles, and given a preventive dose of vitamin A, which prevents a blinding condition known as xerophthalmia. They are also de-wormed and given other vitamins and minerals. In a well-run feeding centre the severely malnourished children should gain weight quickly. Within a month they should be up to 80% or more of their expected weight and ready for discharge into the supplementary feeding programme, in which they will be given take-home dry rations. If MSF teams can get to them early enough, 95% of severely malnourished children can be saved from what would otherwise be certain death. The main constraints to our achieving this outcome in all situations are logistical and political. These are discussed in Fighting a Famine.