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Displaced SAM children under 5 treatment

This question was posted the Management of wasting/acute malnutrition forum area and has 1 replies.

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Nadine Eriksson

Medair

Normal user

9 Jul 2024, 13:58

If screening and identifying new SAM cases among IDPs on the move (e.g. trough mobile service), is it advisable to start RUTF treatment and provide routine drugs - even if it's highly likely that there will only be one point of contact and high risk of no chance of follow up? 

Paul

Technical expert

9 Jul 2024, 17:39

Hi Nadine,

Much depends on context. Assuming that displacement is not primarily due to food insecurity that could be mitigated through other measures (e.g. General Food Distribution), then the decision would be based on in-country coordination and programme design consiering the phase of the emergency and the relevant emergency priorities (Shelter, WaSH, Health etc).

The design should be coordinated with UNHCR (and / or Nutrition Cluster) if active to ensure that your programme design and any advice given appropriately considers identification, registration, protection and other issues. It is possible that while you may not be able to provide all of the facilities, you should try to coordinate with other actors to provide a network of treatment points along the most relevant evacuation corridors and at destination IDP camps / locations. Coordination should allow for registration cards from the first point of contact to be accepted at other waypoint / destination facilities. As far as possible information about any other waypoint or destination services should be supplied if they are available and safe to recommend. Are there any facilities (emergency or otherwise) to treat infants and children with complications?

Other factors such as the vulnerability status of the individual (e.g. age and MUAC on assessment), nutritional status of IDP population and length of journey may also lead you to consider the prioritisation of services.In any case consider,

  • As a mimum also include screening infants and provide relevant IYCF-E support services
  • prevention efforts such as treating MAM cases to prevent SAM
  • Provide 4 -6 weeks of RUTF supply for SAM children (depending on journey length) with follow up and reassessment at least 2 weekly if possible
  • Consider provision of other family rations if sharing is likely
  • Consider remote follow up by phone / video call if safe to do so considering information privacy and storage, client safety, potential for misuse of identity & location data
  • Provide counselling that includes recognition of age-appropriate danger signs to inform family decision making en-route

It is quite possible, if not likely, that a single organisation operating in a limited area would not be able to track individual cases, but a coordinated reporting system with other agencies may at least give some insight into outcomes that could inform future programme design. 

In summary, it is not possible to say if giving the RUTF and medicines is 'advisable' without consideration of other factors and your making appropriate efforts at coordination. If all other factors have been considered and exhausted it would be a judgement call by you or your organisation balancing the ethical imperative to act and ensuring your efforts are lifesaving and do no harm. In such a circumstance being able to report an outcome is, in my personal opinion, a secondary consideration.

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