Hi Syed,
It is debatable whether this should be a new discharge category or whether the discharge should be as 'non-cured'. I tend to favour the latter, as in general I am against creating new discharge categories.
If you categorise them as non-cured, you could then have a section on 'further information' which would distinguish between non-cured because they have not responded to treatment after 4 (?) months or whether they were a planned discharge and were not cured at the time of leaving.
In any case I think this needs to be considered a negative outcome. I think there needs to be very careful thought before introducing planned discharges before cure and should be an action of last resort when nothing else can be done. Efforts should be made to convince them to stay until the child is cured involving other family or local traditional leaders within the IDP community or even religious leaders . They should clearly understand that relocating while the child is still SAM puts the child at great risk. If they are absolutely determined to leave perhaps negotiate that the child stays until at least they are no longer SAM or stays in treatment and / or for a minimum of 1 month. The MUAC should at the very least be in the MAM range if the child started as SAM. Perhaps the caregiver and affected child can delay relocation while the rest of the family relocate (security / protection considerations may make this unlikely).
If you do discharge a child with RUTF and a MUAC tape you must be sure to give training in the use of MUAC and careful messages. MUAC responds in a similar way to weight changes without any lag effect. MUAC also responds in exactly the same way as weight when there is an illness (these will be the subject of a peer reviewed paper being published imminently). It is important to tell the caregiver to take the child to a health facility if the MUAC does not increase each week.
The child with MAM is also at a slightly elevated risk but the physiology is less deranged than that of a SAM child. A planned discharge could be done more immediately and the child discharged with RUSF along with all of the appropriate key messages for the caregiver.
In all cases there should be an emphasis on
- IYCF messaging
- WASH considerations, hygienic food preparation etc.
- Specific messaging regarding the underlying cause of the malnutrition
- Messaging on any medications which must be continued after discharge
On discharge you should provide a detailed discharge slip which explains the treatment given so that the caregiver can give this to a health care provider in the new location if necessary (include your contact phone number). Take the phone number of the caregiver or a close relative, if possible, so that you can follow up the child remotely. You should ensure that any planned discharge must be certified by the programme manager to ensure that as much is done as possible to prevent the early discharge. It is important that this does not become the de facto method of discharge.
I am sure that these thoughts on the topic are not exhaustive and others will have more to contribute to the discussion. Whatever is decided, the safety of the child remains the number one consideration.