Hi Anonymous,
What Jessica has written above is correct. This issue has also been discussed in previous posts on en-net; please see the inputs from Anne Walsh and Michael Golden in this post
https://www.en-net.org/question/171.aspx
There are lots of variations on protocols but some history may help to put this into context. The original reason for NOT giving Vitamin A in CMAM programmes was based on limited evidence that suggested a higher mortality rate if children with oedematous malnutrition were given high dose Vitamin A on admission.
Studies also indicated that daily low dose vitamin A (5000 iu per day) was better for children with SAM with a reduction in morbidity (see the post above and the systematic review by Mark Manary et al. below for detailed discussion)
https://www.who.int/nutrition/publications/guidelines/updates_management_SAM_infantandchildren_review3.pdf
Two things emerged, firstly that the vitamin A content in therapeutic milks and RUTF was likely more appropriate than giving high dose vitamin A on admission to treatment - unless there was the risk of more serious issues such as blindness or death - such that the exception is to give vitamin A to children with vitmain A deficiency with eye signs or with a diagnosis of measles. However, if the therapeutic milk is homemade then adding vitamin A (eg through mineral and vitamin mix) would be appropriate.
Secondly a variation in when, and if, to give vitamin A to oedematous cases arose in guidelines. Some practiitioners suggested that high dose vitamin A should still be given to oedematous cases but only when the oedema had resolved. However protocols being protocols, some guidelines standardised this by saying that vitamin A should be given on week 4; this was to coincide with the giving of measles vaccinations in week 4 (another compromise in some guidelines) or by giving it on discharge. Reading national guidelines one can become confused by the array of interpretations.
Going back to Jessica's reply indicating vitamin A shouldn't be given provided that the child is being given therapeutic foods that comply with WHO standards (i.e. contain vitamin A which will thus be given in a daily low dose in the diet) - except where there are eye signs or mealses, when high doses are required; The dose of vitamin A to be given in these exceptions is dependent on the child's age. Jessica's advice follows the WHO 2013 guidance. You should however comply with any national guidelines as these are usually constructed to accomodate other relevant governmental guidance and adaptations to context.
I hope this helps,
Paul