Milk Powder

Online Training on Facility Based Management
of Children with SAM in Bangladesh


Importance of SAM Online Training System

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Severe Acute Malnutrition (SAM) is an important cause of death in children. SAM affects nearly 20 million pre-school age children, mostly from Africa and south east Asian region. Malnutrition contributes 8 million deaths in children under five years of age worldwide (WHO 2013). Overall risk of death among children with SAM is 9 times more that of well-nourished children.

Level of Stunting among Bangladesh children <5 years declined from 51% in 2004 to 36% and underweight from 41% in 2007 to 22% (BDHS 2017).

Figure: Stunting trend in Bangladesh from 2007 to 2017-18.


Approximately 2% (BDHS 2017) of Under-5 children suffering from SAM only by weight for length or height Z-score (WHZ) <-3criteria. Because there’re no national information on prevalence of SAM using mid upper arm circumference (MUAC) and presence of bipedal oedema in under-5 children, thus the actual number of children suffering from SAM could be much higher than the actual estimate.


Figure: Wasting trend in Bangladesh from 2007 to 2017-18


About the course

Children suffering from SAM can be successfully treated by using WHO guidelines that have been shown to be feasible and sustainable even in small district hospitals with limited resources, where the WHO guidelines have been implemented as recommended, substantial reductions in case fatality rates have been achieved. WHO guidelines are a structured approach to care and involve 10 steps in two phases and taken into account the profound physiological changes that exist in severe malnutrition.

This national guideline is adopted from WHO guidelines, contextualized, and adopted through different level peer review committees.

This online course provides clear and practical guidance for inpatient treatment and management of Under-5 children who are suffering from severe acute malnutrition.

Learning objectives

This course will help you to understand the following areas:

  • Importance of severe acute malnutrition as a public health problem.
  • Assessment of nutritional status for identification of SAM at facility (indoor, outdoor) and outreach sites.
  • Help to understand the principles of care for SAM children.
  • Will help to understand the different steps of management (10 steps for different complication management,  feeding of F-75, F-100).
  • Help to understand the daily care for children including needed antibiotics, monitoring pulse, temperature & weight gain.
  • Will help to understand and monitor the overall treatment performance of SAM word.
  • How to engage the mother in child’s care and prepare for follow up.


This online training would take around 16 to 18 hours in total for reading, observing the module contents, understanding, and answering the quizzes.


  • Doctors: Consultant, Paediatrician, Medical Officers
  • Nursing staff
  • Nutritionists / Dietician
  • Supporting Staff


This course consists of Slide show, tutorials with interactive content and quizzes.

Feedback Certificate IconFeedback and Certificate

Once you have completed the 7 Modules, you will be asked to provide feedback on the course and will be provided with your Certificate of Achievement.

Course Structure

The course is composed of Seven modules:

1.1 Importance of severe acute malnutrition

1.2 Purpose of these training modules

1.3 Course methods and materials

1.4 Learning objectives for modules

1.5 Objectives for clinical sessions

2.1 Defining undernutrition and severe acute malnutrition

2.2 Anthropometric measurement (length/height, weight, MUAC)

2.3 Identify the children with severe acute malnutrition

2.4 How does the physiology of severe acute malnutrition affect the care of the child?

2.5 Overview of the essential component of care

2.6 Discharge criteria for children with severe acute malnutrition from malnutrition ward

3.1 Ten essential steps of management

3.1.1 Manage hypoglycemia

3.1.2 Manage Hypothermia

3.1.3 Manage a child with severe acute malnutrition and shock

3.1.4 Manage very severe anemia

3.1.5 Give emergency eyecare for corneal ulceration

3.1.6 Manage watery diarrohoea and/or vomiting with ReSomal.

3.1.7 Give antibiotics

4.1 Prepare F-75 and F-100

4.2 Feed the child with F-75

4.3 Feed the child in transition phase

4.4 Feed freely with F-100

4.5 Feed planning for the malnutrition ward

5.1 Handle the child Gently

5.2 Caring for skin and bathing the child

5.3 Give prescribed antibiotics and other medications and supplements

5.4 Care for the eyes

5.5 Monitor pulse, respirations, and temperature and watch for danger signs

5.6 Provide continuing care at night

5.7 Weight the children daily and maintain the weight chart

6.1 Use a process to identify and solve problems

6.2 Monitor and solve problems with and individual child

6.3 Monitor overall weight gain on the malnutrition ward

6.4 Monitor child outcomes

6.5 Monitor practices and procedures

6.6 Solve problems  

7.1 Organize ward routine to encourage mother’s involvement

7.2 Involve mothers in comforting, feeding and bating children

7.3 Teach group of mothers about feeding and care

7.4 Prepare for feeding the child at home

7.5 Teach mothers the importance of stimulation and how to make and use toys

7.6 Give general discharge instructions

7.7 If early discharge is unavoidable, make special arrangements for follow up



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