Screening for SAM in the community

Active and early case finding is an important determinant of case fatality rate, programme coverage and the programme impact. Community mobilization is crucial for active and early case-finding.

To reduce the barriers to access, reduce case fatality and improve programme impact, screening must take place in the community and before the onset of medical complications. Active case finding should be done in the community by the ANM and AWW and aided by the SAHIYA of the village. It is important to supplement active case-finding with community sensitization which would lead to self-referral.

Frontline community workers (AWW, SAHIYA, ANM) can identify children with SAM by using simple coloured plastic strips that are designed to measure mid upper arm circumference (MUAC). They should also be able to recognise nutritional oedema of the feet, which is another sign of this condition. Regular growth monitoring at the anganwadi centre or during Village Health and nutrition Day is an opportunity for active case finding.

Once identified, these children with SAM need further assessment to determine if they require referral to health facility and facility based care or whether they can be managed at community level with visits as outpatients to a health centre or facility.

Besides active case finding in the community (through regular growth monitoring at AWC or during VHND) all possible contact opportunities with children should be exploited including home visits, immunisation outreach sessions, visit to sub centres and all levels of health facilities. Assessing the nutrition status of all sick children presenting to health facility should be emphasized and wherever possible, included in physical examination guidelines/formats.