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Multiple treatment failure in TFP - what to do?

This question was posted the Management of wasting/acute malnutrition forum area and has 3 replies.

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Brent Scharschmidt

Malnutrition Coordinator

Normal user

10 Sep 2009, 09:05

In our program we have a girl age 18 months who has entered the therapeutic feeding program twice (most recently her MUAC was 10.5, WFH Z-score unavailable). The first time she received two months of treatment with minimal improvement, the second time she was sent to a referral clinic and discharged after 5 days based on WFH Z-scores, though her MUAC was still below 11cm at the time of discharge. We've just found that she has fallen to MUAC = 10.5cm which is severe by our program's standards. Referral is not an option anymore due to her family's unwillingness. My question is: is it ok to enter her into the supplementary feeding program (a dry ration received weekly) or should she be re-entered into therapeutic feeding? It seems to us a case of failure to thrive, as no other underlying problems have been found except suspected mental health problems in the mother which prevents her from taking proper care (feeding, cleaning the child, etc).

Mark Myatt

Frequent user

11 Sep 2009, 18:08

Difficult. Have you tried second line antimicrobials &c.? In CTC programs we try to recruit mothers who have been through the program and spontaneously show willingness to help new mothers. They become community-based volunteers and their job is (1) case-finding and referral and (2) mentoring of new mothers. I suggest that you see if you can recruit a neighbour or family to help with this problem mother and child. I think this child will not do well in SFP. Just my tuppence.

Tarig Abdulgadir

CMAM Specialist / UNICEF

Normal user

13 Sep 2009, 07:28

Dear, Failure to respond to therapeutic feeding is really challenging in TFPs and it can be multifactorial and depending on the operatioanl area , our experience from Darfur in such cases we think about chronic illnesses like tuberculosis as it is manifested as slow or not at all response to therapeutic feeding( minimal or very little weight gain) these features reverse remarkably when they receive anti tuberculous treatment( diagnosing TB in malnourished child again can be challenge but special score designed for that i think) , many times the reason behind failure to respond may be difficult to diagnose and hence it is unlikely that this child may benifit from SFP , my suggestion is to readmit her to TFP , have senior medical workup for the child and we can ask the family to bring some one with the mother to help her in taking care of the baby

Cécile Bizouerne

Psychologist in Action Contre la Faim France

Normal user

14 Sep 2009, 18:01

As I'm psychologist, I will respond more on the side of the psychosocial aspects and not on the medical issues already highlighted. Not easy to provide suggestions without more information. In some of Acf projects, we used to work with psychosocial workers as part of the CMAM team. They support the mothers with psychological distress and reinforce the mother-child relationship through home-visits and during the time of consultation in the OTP site. If you suspect the mother to have mental health difficulties for taking good care of her child, as previously proposed, an invitation of the rest of the family or neighbours might be helpful for: 1/ better identifying if i) the mother has a mental health problem, ii) the child has specific difficulties in terms of psychomotor and or psychological development, iii) specific problems in the mother/child relationship (for example, mother doesn't want the child or child issued from a rape, etc...) , 2/ trying to find alternative solutions with the family: giving specific support to the mother or finding someone to take care of the child. I don't know in which country your project is implemented and if collaboration and/or exchanges of practices with ACF teams are possible as well.

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