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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

Hello everyone,
We want to conduct a KAP survey of mothers in nutrition in a department that has 51 villages. In these 51 villages, we set up FARN (Learning and Nutritional Rehabilitation Centre). We want to use 2 stage cluster sampling: the first stage selecting the villages and the 2nd stage households.

Should we include all the villages? otherwise how do you make the selection?
We have the population of each village and also that of children from 6 to 59 months. The size of the population differs per village. And so, we used the probability proportional to the size to have the places of the clusters in all the villages.
My concern here is whether we have to use the total population or the population in the age range of 6 to 59 months to calculate the sampling interval?
What is the point of having the sample size if we proceed by households?
Finally, is it possible to limit our investigation just to our FARNs (Learning and Nutritional Rehabilitation Centers) since they are implanted in all villages (51)? I fear a bias because mothers who come to these homes are sensitized daily. This may affect their answers to some questions.
I remain available for more precision.

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