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Disharge criteria

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 1 replies.

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Normal user

6 Mar 2014, 14:05

The question on discharge criteria and matching with guidelines. we found more than one case on OTP they reach target weight for discharge (15% weight gain, according to protocol ) and MUAC still < 115 .e.g. one case stayed for more than 6 weeks on treatment MUAC 88 mm and WHZ <-3 and reach the target weight. how can i manage such sitiuation , discharge cured, or continue on treatment until reach discharge target by MUAC >115 that contradicted with protocol in disharge. Is there any protocol Mentioning that if a child admitted by MUAC not by WHZ should stay for at least two monthand dicharge cure even his MUAC l <115? thank you

Mark Myatt

Consultamt Epidemiologist

Frequent user

6 Mar 2014, 15:34

I don't know where you are writing from but discharging below the admission criteria is not a reasonable thing to do as you will have to re-admit the case immediately since they are below the admission criteria. That could solve you problem ... discharge and readmit until the MUAC is > 115 mm. Two admissions should do it as weigh gain would be: 1.15^2 - 1 - 32.25% at discharge. So, maybe it is a rational thing to do. You really cannot discharge at MUAC = 88 mm. The problem with proportional weight gain is that the most waisted get the least treatment and the last waste get the most treatment. This has been well-documented by teams from MSF and elsewhere. Work is ongoing on using MUAC for discharge. Work by MSF and VALID International show that this addresses the "worst get the least" problem. Work in press by VALID shows that discharge at 125 is safe (i.e. associated with very low levels of relapse or death) and can be achieved with reasonable treatment periods. With MUAC = 88 mm we can expect long treatment times. BTW : Proportional weight gain was proposed by me about eight years ago. It is my mistake (and a big mistake too). I hope this helps.

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