The MSP approves guidelines to detect acute childhood malnutrition in emergencies

The Ministry of Public Health approved and authorized the publication of the guideline titled “Evaluation of Acute Malnutrition in Emergency Situations in Ecuador,” through Ministerial Agreement No. 00018-2026, signed on October 6, 2026, by Minister Juan Carlos Aveiga Parra. The instrument was published in Official Registry No. 392 on Monday, October 19, 2026, in its Executive Branch section, and consists of five pages of agreement and a 42-page technical annex.

The document establishes the procedures for the timely evaluation and identification of acute malnutrition, its classification, referral, and follow-up in girls and boys under five years of age during emergencies. According to the text, it is “of mandatory compliance for the entire National Health System, across its different levels of care and territorial management scopes.”

The starting point: a country exposed to multiple threats

The guideline is justified by Ecuador’s exposure to geological, hydrometeorological, biological, and anthropic events, with special mention of the El Niño-Southern Oscillation (ENSO) phenomenon, which affects the Coast, Highlands, and Amazon regions differently. These situations cause human mobility, interruption of basic and health services, and food insecurity, which increases the risk of childhood nutritional deterioration.

As an epidemiological reference, the National Survey of Childhood Malnutrition (ENDI) reports a prevalence of acute malnutrition of 1.1% in children under 2 years, 0.7% in children under 5 years, and 0.4% between 2 and 5 years. The document warns that, although these figures are lower than those of chronic malnutrition, the condition requires immediate identification due to its rapid progression.

The regulation is aligned with the Multi-Hazard Response Plan of the Ministry of Public Health, approved through Ministerial Agreement No. 00037-2025, and with the Health Emergency Situation Room, which determines the level of activation and deploys guidelines to provincial directorates, technical offices, and health facilities.

Screening with MUAC tape and color classification

The guideline prioritizes the measurement of the Mid-Upper Arm Circumference (MUAC) as a screening tool for girls and boys from 6 to 59 months, given the limitations in access, infrastructure, and equipment inherent to an emergency. The classification criteria are:

• Red, less than 11.5 cm: severe acute malnutrition.
• Yellow, from 11.5 to less than 12.5 cm: moderate acute malnutrition.
• Green, from 12.5 to less than 13.5 cm: risk of acute malnutrition.
• Green, 13.5 cm or more: normal nutritional status.

In children under 6 months, mid-upper arm circumference is not applied as a diagnostic criterion: weight-for-length and the presence of nutritional edema are evaluated. For the weight-for-height or length indicator, severe acute malnutrition is classified below -3 standard deviations and moderate between -3 and -2. Bilateral pitting edema is graded as mild (+), moderate (++), and severe (+++).

Action flows and mandatory registration

First-level health teams, supported by mobile brigades, must guarantee calibrated scales, stadiometers or infantometers, MUAC tapes, and personal protective equipment. Individual registration is made in Form 008 for Emergency Care and is consolidated in a matrix that reports the total number of evaluated individuals, their classification, referred cases, and follow-up status.

In a case of severe acute malnutrition or bilateral edema, the referral must be “immediate and priority,” without delaying the derivation, to the nearest facility with resolution capacity or, failing that, to the Comprehensive Public Health Network and the Complementary Network. Follow-up must confirm the receipt of the case, the clinical-nutritional management, the evolution of the nutritional status, and the closure of the process.

The technical annex also includes a classification, response, and follow-up matrix and an institutional flowchart model for the evaluation and referral of cases in children under five years of age. The preparation was carried out by the National Directorate of Healthy Eating and Nutrition and the National Directorate of Health Policies, Norms, and Modeling, with review by specialists from UNICEF Ecuador and the Ecuadorian Red Cross.

The instructional guide provides the health system with a single protocol for the early detection of a problem that worsens rapidly in disaster contexts, when access to food, safe water, and health services is interrupted. Its mandatory application at all levels of care seeks to prevent the emergency from leading to irreversible nutritional deterioration in the population under five years of age.

Source: Official Registry No. 392, Monday, October 19, 2026, Section I (Executive Function), p. 2 (official reference: Ministerial Agreement No. 00018-2026).