e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Treatment of hypoglycaemia in children with severe acute malnutrition

Intervention | Last updated: 19 May 2023

In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.

All severely malnourished children are at risk of developing hypoglycaemia – or low blood sugar – which can rapidly lead to death if not treated. Hypoglycaemia may be caused by a serious systemic infection or can occur when a malnourished child has not been fed for 4–6 hours.

The treatment or prevention of hypoglycaemia and hypothermia should be included in the initial treatment a severely malnourished child receives when first admitted to hospital.

WHO Recommendations

All severely malnourished children are at risk of hypoglycaemia and, immediately on admission, should be given a feed, or glucose or sucrose solution.

If the child is conscious and able to drink, glucose or sucrose should be given orally or by nasogastric tube followed by small and frequent feedings with F-75 therapeutic milk.

If the child is unconscious, glucose should be given intravenously, or glucose or sucrose by nasogastric tube. When the child regains consciousness, small and frequent feedings with F-75 therapeutic milk should be started.

All malnourished children with suspected hypoglycaemia should also be treated with broad-spectrum antimicrobials for serious systemic infection.



Evidence

No systematic reviews identified

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Cost-effectiveness analyses

The analyses listed below were conducted to assess the overall cost-effectiveness of inpatient and/or outpatient management of SAM, of which the intervention listed on this webpage is a component. The analyses do not assess the cost-effectiveness of this specific intervention alone.

Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia

Tekeste A, Wondafrash M, Azene G, Deribe K.<br>\r\nCost Eff Resour Alloc. 2012; 10:4.

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Goudet S, Jayaraman A, Chanani S, Osrin D, Devleesschauwer B, Bogin B, et al.<br>\r\nPLoS One. 2018; 13(11):e0205688.\r\n

The cost-effectiveness of forty health interventions in Guinea

Jha P, Bangoura O, Ranson K.<br>\r\nHealth Policy Plan. 1998; 13(3):249-62.\r\n

Costs, cost-effectiveness and financial sustainability of community-based management of acute malnutrition in northern Nigeria

Frankel S, Roland M, Makinen M.<br>\r\nWashington DC: Results for Development Institute; 2015.\r\n

Economic Cost of Community-Based Management of Severe Acute Malnutrition in a Rural District in Ghana

Abdul-Latif A-M C, Nonvignon J.<br>\r\nHealth. 2014; 6: 886-899.\r\n

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh

Puett C, Sadler K, Alderman H, Coates J, Fiedler JL, Myatt M.<br>\r\nHealth Policy Plan. 2013; 28(4):386-99.

Cost-effectiveness of community-based management of acute malnutrition in Malawi

Wilford R, Golden K, Walker DG.<br>\r\nHealth Policy Plan. 2012; 27(2):127-37.\r\n

Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model

Bachmann MO.<br>\r\nCost Eff Resour Alloc. 2009 Jan; 7:2.

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

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Essential Nutrition Actions

This intervention is a component of managing children with SAM, which is an Essential Nutrition Action targeting the first 1000 days of life.

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