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discharge criteria of SAM

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 6 replies. You can also reply via email – be sure to leave the subject unchanged.

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Anonymous 1612

Director, Health & Nutrition, Terres des hommes

Normal user

23 Jun 2013, 11:14

In a CMAM program where RUTF (EezyPaste) is provided to SAM children under 5 with no complications, when should they be discharged, meaning on what criteria (MUAC and WHZ)? Is it okay to treat the child with RUTF till they reach normal measures (>12.5 MUAC and/or < -1 SD for WH Z-score)? While in one area we are providing RUTF for SAM children till they reach MAM criteria, and then giving supplementary food (WSB++) during MAM, in another area we do not have the WSB support. Would it be all right to continue treatment with RUTF till they reach normal status?
Clarification and/or advise is sought. Thanks.

Hamid Hussien

Nutrition Specialist Concern WW

Normal user

23 Jun 2013, 19:55

Hi
most nutrition guidelines define discharge criteria in SAM without complication as child with MUAC equal or more 11.5 cm together with weight gain 15% and there is no nutritional Oedema or resolved
in some cases due to lack or no any MAM centers (SFP programs) SAM children continuing get RUTF until they reached MAM discharge criteria to reduce risk of being severe acute malnourished again
i think you can deal with this strategy until you establish SFP program in target area

Anne Walsh

Normal user

24 Jun 2013, 10:02

Where you have no SFP to discharge the children to then they should reach a MUAC of > or = 12.5cm. You may add "sustained weight gain for 2 consecutive weeks and clinically well" before discharge. The practice of giving 7 packets of RUTF on discharge is good practice to help them transition back to family foods.

Continuing RUTF until normal is not recommended, it is designed as a treatment for SAM and not to replace other foods once the child has recovered from SAM.

Whilst % weight gain was recommended as an option for discharge in 2007, the guidelines that are due from WHO will no longer recommend %wt gain as a discharge criteria. So if you are currently not using %wt gain then don't introduce it now.

Elh.Hallarou Mahaman

Nutrition Consultant

Normal user

24 Jun 2013, 10:42

Hi,
in addition to MUAC thresholds, in Niger, we also consider W/H = -1,5 Z-score as discharge criteria where there is no SFP.

Elh.Hallarou Mahaman

Nutrition Consultant

Normal user

24 Jun 2013, 11:03

Please read "W/H = -1,5 Z-score" in previous post

Tamsin Walters

en-net moderator

Forum moderator

2 Jul 2013, 14:18

From Ehsanul Matin:

Thanks Hamid H.for the suggestion. Has this measure of continuing RUTF till MAM discharge criteria been taken any where? If yes, what were the outcomes and any info on their later status like after 3 months or 6 months after treatment ended? Thanks

Hamid Hussien

Nutrition Specialist Concern WW

Normal user

2 Jul 2013, 20:07

Between June 2010 and December 2011 high rates of malnutrition recorded in Glaa Alnahal and Alguraisha localities Gadaref State Eastern Sudan
Ministry of Health in collaboration with MSF conducted emergency nutrition program in both localities
These interventions included inpatient and outpatient care treatment (CMAM components)
In the absence of funded supplementary feeding state (WFP) they start to use therapeutic food (RUTF) as a way to manage acute malnutrition without complications and Moderate malnourished cases
Shaking strategy proved effective in the malnutrition treatment contributed almost 5,000 cases most of them moderate malnutrition cases and significantly reduced the mortality rate which is normal evidence previously
After the expiry of the program MOH and MSF conduct monitoring surveys in the period of hunger and harvest seasons and also set up surveillance system to monitor the situation and the results showed a decline of full cases of malnutrition all cases very simple being treated through the centers of the ministry and then MSF decide to end their operation there due to great impact or success of that strategy

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