[Management of severe malnutrition in children in tropical climates]

Severe malnutrition is defined as a weight for height index less than-3 standard deviations (SD) from the NCHS reference or the presence of edema. Without appropriate treatment, the risk of death is high. The WHO now proposes a standardized treatment protocol that consists of first treating initial complications and then two-phased feeding with two therapeutic formulas (milk F75 and milk F100) made of dried skimmed milk, oil and sugar highly supplemented with vitamins and minerals but containing no iron. Milk F75 featuring moderate protein and energy content is used for the first few days until associated infections are under control and anorexia disappears. Milk F100 featuring higher energy and protein content that allows high weight gain is subsequently used for nutritional rehabilitation. Milk F100 is gradually replaced by solid diets for home based nutritional rehabilitation.