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

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Make Hope for Development

Normal user

22 Jun 2021, 22:19

The Z-SCORE in Yemen for Outpatient therapeutic program(OTP) was based on the Z-SCORE which was adopted by the World Health Organization as a result of the arithmetic mean values for males and females. However, there are some problems with the admission of a child who has failed to respond to outpatient therapeutic program(OTP) when he or she is transferred to the therapeutic food center(TFC). As some of the children who are transferred to the therapeutic food center(TFC) don't meet the admission criteria in the therapeutic food center(TFC).
 What about this?


Technical expert

13 Jul 2021, 16:07

Hi Mohammed,

The use of sex-combined weight-for-height tables is quite common and shouldn't be problematic in most cases. In the CMAM context the TFC and OTP should operate according to common admission and discharge criteria. This can occasionally be an issue when different organisations implement different components of the programme in emergency contexts - but these issues should be resolved at coordination meetings (e.g. through the nutrition cluster or similar). If there are national guidelines then those can be used to standardise the criteria between agencies. 

In OTP a child may be recovering (and now doesn't fit the admission criteria) but is not responding to treatment and acheiving cure. These non-responders should be referred to the TFC, as you suggest, and in the CMAM context the TFC should have admission criteria that include children that are not responding to treatment in OTP. 

So it seems that some coordination between the TFC and OTP implementers is required with agreement on admission, transfer and discharge criteria. 

Does this answer your question?



Make Hope for Development

Normal user

17 Jul 2021, 17:55

Thanks Dr Paul

Mahamadou Adamou

Nutritionniste/Direction de la Nutrition

Normal user

17 Jul 2021, 22:42

In Niger, we opted for the Z-Score and the MUAC to be independent criteria for admission to the various nutritional rehabilitation programs and this during the revision of the national protocol for integrated management of malnutrition (PCIMA) in 2016. However, some children do not respond to treatment. It is important to look for the cause of the non-response which may be linked to an underlying pathology, factors linked to the community (e.g. sharing of the ration with the other children of the household ...; factors linked to the health center (e.g. frequent breaks in availability of inputs, exceeding the capacity of the center, etc.).

Indeed if after examining those factors we decide to refer the child, it is necessary to ensure that he/she meets the admission criteria of the structure which should welcome him.

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