Malnutrition
Malnutrition services
provides quality, safe and comprehensive care to all patients that are admitted
or transferred to FMIC. Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients or impaired nutrient utilization. The double burden of malnutrition consists of both undernutrition and overweight and obesity, as well as diet-related noncommunicable diseases.The clinical management of patients is
built on problem-solving and evidence-based decision-making. The Healthcare
team provides emotional, social, and culturally sensitive support to
patients/families. Patients are discharged when hospitalization is no longer
needed. Usually patients are seen by consulting physician after their discharge
or as per need to follow up on their progress.
Referral criteria of Severe Acute Malnutrition (SAM) patients from other hospitals and SAM
centers to FMIC
1) Medical Complications associated with Severe Acute Malnutrition (SAM) which are
manageable in the IPD-SAM independently:
a) Severe Acute Malnutrition (SAM) resulted in:
i) Primary failure
ii) Secondary Failure
b) Severe Acute Malnutrition (SAM) complicated with:
i) Volume Overload
ii) Septic Shock
iii) Electrolyte Imbalance
iv) Renal Failure
v) Severe Pneumonia
vi) Congestive Heart Failure
vii) Central Nerve System (CNS) Infection
viii)Dilated Cardiomyopathy (DCM)
ix) Urinary Tract Infection (UTI)
2) Surgical conditions/complications associated with SAM which are manageable in the FMIC,
IPD-SAM with support of Woman Child Health (WCH) project:
a) Central Nervous System (CNS) defects such as:
i) Meningocele
ii) Spina bifida
iii) Hydrocephalus
iv) Craniocynostosis
v) Occipital Mass
vi) Lumbar Mass
b) Congenital Heart Diseases (CHDs) such as:
i) Ventricular Septal Defect (VSD)
ii) Patent Ductus Arteriosus (PDA)
iii) Atrial Septal Defect (ASD)
iv) Pulmonary Stenosis (PS)
v) Aortic Coarctation
c) Congenital Pyloric Stenosis
d) Urogenital anomalies such as:
i) Obstructive Uropathy
e) Complex general surgery such as:
i) Undescended testes
ii) Esophageal stenosis
iii) Axillary mass
iv) Vaginal atresia
v) Hydatid cyst
vi) Congenital Diaphragmatic Hernia
vii) Imperforated anus
f) Complex orthopedic problems such as:
i) Club foot
ii) Development Dislocation of the Hip (DDH)
iii) Fractures
iv) Osteomyelitis
v) Deformities
g) Defects/injuries which need plastic/reconstructive surgeries such as:
i) Burn injuries
ii) Cleft lip
iii) Cleft palate
iv) Infantile Hemangioma
h) Ophthalmic conditions such as:
i) Cataract
ii) Blepharophimosis
i) Complex Ear, Nose, Throat (ENT) Surgeries for diseases such as:
i) Nasal Obstruction
ii) Nasal Polyps
3) Suspected syndromes or other diseases associated with Severe Acute Malnutrition (SAM)
which cannot be diagnosed and treated inside the country could be referred abroad due
unavailability of service here at FMIC and even in Afghanistan, including the following ones:
a) Spinal Muscular Atrophy (SMA)
b) Cystic Fibrosis
c) Liver Metabolic Disease
d) Inborn Error of Metabolism (IEM)
e) Celiac Disease
f) Endocrine Diseases which need further workup
g) Malabsorption Syndrome
h) Pancreatic Ascites which needs Endoscopic Retrograde
Cholangiopancreatography (ERCP) or Magnetic Resonance
Cholangiopancreatography (MRCP)
4) Diseases associated with Severe Acute Malnutrition (SAM) which are not manageable
neither in FMIC, IPD-SAM nor in the WCH project:
a) Congenital Heart Diseases (CHDs) in children weighing less than 5kg
b) Tetralogy of Fallot (ToF) in children less than 6kg
c) Critical patients cannot be directly referred to FMIC, IPD-SAM from other tertiary care
hospitals prior to stabilizing them.
d) End stage patients cannot be referred to FMIC, IPD-SAM from any other hospitals to
avoid wastage of resources without optimal outcomes and to enhance bed availability
for SAM patients with better prognosis.
e) Cerebral Palsy (CP) patients
