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Weight gain in SC, is it a performance indicators?

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 10 replies. You can also reply via email – be sure to leave the subject unchanged.

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Jean NADEMBEGA

Nutrition Program Manager / Save the Children Ca

Normal user

21 Jul 2011, 13:23

Previously we used to measure the weight gain in SC but since the consultancy of VALID we no longer take it into account as it is not for nutrition reason that the child have been admitted to the hospital. Since the admissions into SC are for medical reason, the weight might not be usufull. We monitor more the lenght of stay and the death occured in more or less two days from the admission date. It is appropriate to consider 24 hours less or more but due to our context we had adjusted to two days.

Is there any comments??

Anonymous 303

Normal user

21 Jul 2011, 17:31

SC follows phase I and transition phase protocol. In phase I children are not supposed to take on weight due to low calory diet (100Kcal/Kg). So, I agree, weight gain is no more a performance indicator. Lenght of stay may not be a good performance indicator neither, where other factors may delay exit (high prevalence of chronic conditions like HIV, delayed exit due to transport availability, etc). So, how do we measure performance? Death rate is fine, but we need data re the acceptable threshold. I hope someone will take the initiative to collect and publish SC death rate from 'well working' SC. Maybe the new Sphere handbook will include SC specific indicators, does anybody know if that is the case?

Anne Walsh

Normal user

27 Jul 2011, 23:45

The Sphere handbook does not give specifics for SC as it looks at integrated SAM treatment outcomes. The 2011 handbook is available on www.sphereproject.org.
Length of stay should be between 5-7 days in the SC, but some find up to 10 days more realistic to account for delays in lab results, medical consultations etc. But LOS in the SC is the best indicator as it will show if the SC is working efficiently and children are being transfer to OTP as soon as they reach SC discharge criteria (appetite returned, medical condition stabilised). If it is taking longer then there must be problems with treatment, procedures, or staff training within the SC. Delayed discharge increases the risk of default so action needs to be taken to address reasons for delayed transfer/ discharge to OTP.

Anonymous 2339

Health & Nutrition Advisor

Normal user

20 Oct 2014, 09:51

Thank you all for the valuable comments!

Best regards

Isak

Elh.Hallarou Mahaman

Nutrition Consultant

Normal user

20 Oct 2014, 10:33

Hi,
I believe it will be a bit difficult to have consensus on " standard LOS" for SC because of the numerous, various type of complications children have at admission especially in SCs integrated in pediatric facilities of government hospitals. For having done Pediatric Health Care improvement ( PHI) for years, I would rather suggest to keep 24H death rate along with 1 or 2 Emergency stabilization process indicators.
Of course, PHI process indicators are not yet " sphere standards" but they are very useful for monitoring " your " SC performance.

Dr Basil Kransdorff - e'Pap Technologies - info@epap.co.za

CEO - e'Pap Technologies

Normal user

20 Oct 2014, 12:50

The weight gain issue is an interesting anomoly that has crept into interventions and monitoring. We define weight gain into 2 catagories. We refer to obesity weight gain and lean body mass weight gain as 2 distinct different weight gain types. The important weight gain for malnourished people and also so called healthy people should be lean body mass. The obestity weight gain is a problem to everybody and can be caused by excess refined sugar or refined sterile carbs in an unbalanced sterile diet with no excercise. What often falls through the cracks is the role micro nutrients play in lean body mass weight gain and also in better managing the obesity fat issue. A lack of micro nutrients play an important role in the onset of a tired over worked pancrease trying desperatly to manage the sugar surges that result from excess refined sterile carbs. Obesity weight gain is certainly not a measure of good health or a positive nutritional interventions. If this was so - it would be cheaper and easier to pour sugar water down the throats of malnourished kids. Because often weight gain is not differentiated, obesity weight gain in thin malnourished people can wrongly be interpreted as healthy weight gain. This has sadly resulted in a proliferation of ready to use theuropeutic foods whose impact is based on refined sugars. An interesting observation we see. We know when people are highly deficient in micro nutrients - it can supress medical symptoms. Good examples are malaria and TB. As the micro nutritional status gets sorted out and comes back into a state of nutrient repleteness - the medical symptons emerge and can be quickly recognised and treated by a medical doctor. How many negative sputim rests have we all heard about on feverish coughing malnourished patients. In relation to weight gain - we see for example - an imediate weight gain within days of a a nutriitonal intervention that focuses on micro nutrient repleteness (lean body mass weight gain). By monitoring weight daily - if a medical condition then starts to emerge, normally this will be translated into a weight drop which is an important signal to get the person immediatly examined by a medical doctor for an emerging medical sympton which could be TB or malaria for example. So many people die because symptons are supressed because of low micro nutrient status and therefore the medical condition is not properly identified and then of course medically treated. Hope this helps - we need to relook at weight gain issues within a holistic understanding described above and in relation to micro nutrient status.

André BRIEND

Frequent user

20 Oct 2014, 13:10

Children remain in the stabilisation phase as long as they have associated medical complications. During this early treatment phase, the nutritional objective is to maintain body weight, not to get weight gain, as the metabolism is not yet ready to let the body lay down new tissues. This is achieved by providing just the quantity of energy needed to maintain body weight along with nutrients needed to correct possible associated deficiencies. If this is respected, there is no weight gain during this treatment phase. For this reason, it does not make sense to use average weight gain as an indicator of success of the stabilisation phase when evaluating how well a programme is functioning. This criterion shoud not be used for programme evaluation. Having said that, careful and frequent (at least daily) weight measure is key to monitor patients clinically at the individual level.

Mark Myatt

Consultant Epidemiologist, Brixton Health

Frequent user

20 Oct 2014, 13:38

In stabilisation phase we would normal transfer to OTP when oedema was lost (we'd see some weight loss) and / or infections were treated and/or appetite had returned. We are not really expecting much weight gain. So ... I think weight gain is not very useful in SC. We'd monitor weight to see oedema loss and we'd not want to see weight loss in non-oedematous cases.

Just my tuppence.

Tamsin Walters

en-net moderator

Forum moderator

20 Oct 2014, 17:53

Dear Dr Kransdorff,

Thank you for your response and for highlighting some concerns around use of weight gain as a sole criteria for assessing improvements in nutritional status, particularly in the context of obesity.

However, I think the statement "...This has sadly resulted in a proliferation of ready to use therapeutic foods whose impact is based on refined sugars..." is a bit misleading to readers as the discussion here is about emergency contexts for which the use of ready to use therapeutic foods (RUTF) has been endorsed by the WHO/UNICEF/WFP/UNSCN Joint statement on Community Based Management of Severe Acute Malnutrition, found here

This document also provides a little more detail on the composition of approved RUTF, illustrating that these products are designed to assist in the restoration of micronutrient balance and repleteness.

Best wishes,
Tamsin

Mark Myatt

Consultant Epidemiologist, Brixton Health

Frequent user

21 Oct 2014, 08:40

The offending poster has a commercial agenda. The post is off-topic. I doubt the poster understands what "SC" refers to.

Mark Myatt

Consultant Epidemiologist, Brixton Health

Frequent user

22 Oct 2014, 09:44

Not only that ... RUTF is not the issue here because a child with appetite for RUTF would be unlikely to require phase I stabilisation care. The main SC therapeutic feeding product will be an F75 milk. RUTF might only be given in the last day or two of the stabilisation phase ... possible even just as an RUFT appetite test.

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