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Determine number of Children treated for period longer than two months in OTP

This question was posted the Management of wasting/acute malnutrition forum area and has 5 replies.

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Tajudin Ahmed

ENO

Normal user

26 Aug 2022, 17:44

Is it possible to determine the number of uncomplicated SAM children treated for a period longer than 2 months in OTP just from monthly District TFP report? To be clear this is not to mean LOS of individual cards/cases!

Veronica Mulenga Kalandala

Nutritionist ministry of health

Normal user

27 Aug 2022, 07:22

It's possible, because this information is supposed be in the register books also books and report forms which we normally send to the district.

Mark Myatt

Frequent user

27 Aug 2022, 10:43

This will depend on what is included in the district report. I am often frustrated by these reports and have usually addressed such questions by pulling data from OTP registers and OTP beneficiary record cards that fit with the required analysis. In one case (Nigeria) we pulled about 100,000 OTP beneficiary records cards. It was quite an effort but is is do-able. It will not always  be practical if you want o look at a particular district.

If you have mean LOS with a standard deivation then you could use a PROBIT type estimator (not hard to do ... ask here if you need an example) to estimate the proportion with LOS > 2 months but you'd also want to be able to have this data for Uncomplicated SAM cases. You could work with expectations of proportions with uncomplicated SAM and adjust estimates accordingly but this might yield only very approximate results which may be inaccurate if the model used does not match will with reality.

Tajudin Ahmed

ENO

Normal user

27 Aug 2022, 19:48

Dear Mark,

Thank you very much for your prompt response and much appreciated, my question was to ask if it's possible to determine children (uncomplicated SAM) who have been on treatment for period (>2months) just from the monthly statistics report. 

I'm thinking that if  we can calculate the retention rate (RR) to determine the number of cases retained on program in two consecutive months! for instance using the following  formula: [(E-N)/S] x 100 = CRR . See below steps in detail. 

  1.  First identify the time frame you want to study (which is two months in our case).
  2. Next, collect the number of existing cases at the start of the first month of the two consecutive months (S)
  3. Then find the number of total cases at the end of the last month (E)
  4. Finally, determine the number of new cases added to program within the two consecutive months (N). 

All this data are often incorporated in the monthly TFP report of particular districts or facilties.

Finally, don't hesitate to drop your comments  

Mohamed Hassan Mohamed

lecturer

Normal user

29 Aug 2022, 04:19

Mark Myatt

Frequent user

29 Aug 2022, 10:54

I find the monthly reports tend to be tailored to simple program monitoring indicators and many of these were decided when we had little experience with CTC/CMAM programming.

If you have mean and standard deviation for length of stay then it is quite simple to estimate the proportion of cases with LOS > 2 months uisng the "probit" approach. For example, if:

    mean LOS = 46.22 days
    SD LOS = 22.66 days

We can use the normal distribution to calculate the probability thatany simple LOS is > 61 (c. 2 months) in R:

    pnorm(q = 61, mean = 46.22, sd = 22.66, lower.tail = FALSE)

gives p = 0.2571197 .. so LOS > 61 days like in 25.71% of cases.

In Excel:

    =1-NORM.DIST(61,46.22,22.66,TRUE)
    
gives 0.257119741 which is also 25.71%

You can convert this to number sof children by calculation 25.17% of admissions.

This assumes that LOS is normally distributed.

I you cannot find the SD for LOS then you can make rough guesses using the minimum and maximum values with "range rules" such as:

    mean(x) = min(x) + ((max(x) - min(x)) / 2

    sd(x) = ((max(x) - min(x)) / 4

PRIBIT estimates using mean and sd derived from these rules-of-thumb will be very approximate.

I think one problem is that we do not really know the data to hand is for "uncomplicated cases" only. Maybe needed > 2 months to recover suggests a complication of some kind.

This may take you nowhere!
 

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