Classify severe acute malnutrition by MUAC, weight-for-height z-score, and bilateral oedema.
WHO/UNICEF 2023 criteria. F-75 / F-100 / RUTF feed volumes. Offline-capable.
For qualified healthcare professionals only.
SAM criteria and F-75/F-100 volumes sourced from WHO Guideline on the Prevention and Management of Wasting and Nutritional Oedema (2023), UNICEF SAM treatment guidelines, and national CMAM protocols for Nigeria (FMOH), Kenya (MOH), and Ghana (GHS). This is a screening/triage tool; WHZ is only an approximation here and must be verified with WHO growth standards/official chart software.
Always apply clinical judgement. Report an error
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Clinically reviewed by
Dr. Chioma Okafor, FWACP (Paeds)
Consultant Paediatrician, University of Nigeria Teaching Hospital
Updated 2025-09-15
Step 1 — Country / Programme
Step 2 — Anthropometric Measurements
kg
cm
mm
SAM <115MAM 115–125≥125 Normal
Step 3 — Clinical Status
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F-75 Feed Frequency Guide (Phase 1 — Stabilisation)
Severe acute malnutrition (SAM) affects over 13 million children globally, with Nigeria bearing the highest absolute burden in sub-Saharan Africa — approximately 2.5 million children with SAM as of 2023 (UNICEF). SAM is defined by a MUAC <11.5 cm, weight-for-height z-score <−3, or bilateral pitting oedema regardless of anthropometry. Rapid MUAC-based triage at community and facility level, correct classification into complicated versus uncomplicated SAM, and appropriate therapeutic feeding (F-75 stabilisation followed by F-100 or RUTF rehabilitation) are the cornerstones of SAM management. This tool implements WHO 2023 SAM management guidelines and FMOH Nigeria Community Management of Acute Malnutrition (CMAM) protocols.
In children 6–59 months: MUAC <11.5 cm (red zone) = SAM — requires immediate treatment. MUAC 11.5–12.4 cm (yellow zone) = moderate acute malnutrition (MAM) — supplementary feeding programme. MUAC ≥12.5 cm (green zone) = adequate nutrition. Bilateral pitting oedema (kwashiorkor) = SAM regardless of MUAC. SAM can also be defined by WHZ <−3 SD.
F-75 (75 kcal/100 mL, 0.9 g protein/100 mL) is used in the stabilisation phase (first 1–7 days) to correct metabolic derangements (hypoglycaemia, electrolyte imbalances) without triggering refeeding syndrome. F-100 (100 kcal/100 mL, 2.9 g protein/100 mL) is used in the rehabilitation phase for rapid catch-up growth once the child is medically stable.
RUTF (e.g. Plumpy'Nut — 500 kcal/92g sachet) is used for uncomplicated SAM managed in community settings through CMAM programmes: children who are alert, have appetite (pass the appetite test), no bilateral oedema, and no medical complications. Children with complicated SAM (no appetite, bilateral oedema, medical illness) must be admitted for inpatient management with F-75 first.
Inpatient stabilisation is required in SAM when any of the following are present: anorexia (failed appetite test — refuses >75% of RUTF portion), medical complications (pneumonia, severe dehydration, high fever >39°C, hypoglycaemia, severe anaemia, altered consciousness, hypothermia), oedema grade +++ (severe bilateral pitting oedema), or failure to gain weight after 3 weeks of outpatient treatment. Any child with SAM under 6 months should be managed as an inpatient. Community-based (CMAM) programmes are appropriate for uncomplicated SAM with good appetite.
All children admitted with SAM should have blood glucose checked immediately. If glucose is below 3 mmol/L (54 mg/dL): give 5 mL/kg of 10% dextrose IV or 50 mL of 10% glucose by NG tube, then start 2-hourly feeds with F-75 formula. If the child is unconscious, use the IV route. Avoid 50% dextrose — the concentrated glucose causes osmotic injury. After correction, continue 2-hourly F-75 and monitor glucose until stable. Hypoglycaemia in SAM is commonly associated with hypothermia and infection — treat all three simultaneously.
For rehydration using modified low-osmolarity ORS (ReSoMal) in SAM, refer to the ORS Rehydration Calculator.
To monitor clinical status of a child with SAM during stabilisation, use the PEWS Score Calculator.
📋 Guideline basis: WHO/UNICEF CMAM 2007 · WHO SAM 2013 · FMOH Nigeria · Last reviewed: January 2025 · Next review due: January 2026 · Disclaimer · Report an error
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