guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 120
Sometimes a patient has a third number; for example, if there is an in-patient facility attached to a
district hospital and the patient has been transferred from OTP as an outpatient, then the patient will
have a) a SAM number assigned by the OTP site, b) a In-patient sequential registration number for the
malnutrition unit and c) a hospital number. These registration numbers must be kept distinct and
marked in different places on the charts and transfer forms. The critical number is the SAM-number.
This SAM number is assigned where the patient is first treated, whether this is an OTP site or in the Inpatient
facility. This number is unique and should always be denoted as the SAM-No. In all the
documents relating to the patient, i.e. for in-patient care - on Multi charts, registration book and
transfer forms; for Out-patient care, on the OTP chart, registration book and transfer forms. Where
there is a National health card, road-to-health chart or other monitoring document then the SAM
number and the admission must be entered into that document retained by the caretaker.
The SAM- Number is a multi-component number made up of the following components:
For example:
Code for facility where first treated / patient assigned sequential number
• If a patient is first treated from District of Sebrah in an OTP named “Najid health centre”. That
patient may have the SAM number of ;
• The 156 th patient first treated at the district hospital of Goma may have the SAM number of
.
The code for each facility, whether it is an OTP site or an In-patient facility, is set by the District
Nutrition officer or the person who has control of the whole programme in the district. Each
agency or NGO must liaise with the District Nutrition officer/District Nutrition focal point (or in
his/her absence the District Medical Officer), and be assigned a code before a new OTP or IPF is
opened.
This number should be recorded on the Multi-charts and in the registration book for in-patient care
and in the registration book and OTP chart for out-patient care.
2. Definitions used in compiling the reports
Categories of patient
• Oedematous and wasted patients are always reported separately. All new admissions to OTP or
IPF need to be differentiated by type of malnutrition in the report 188 .
• The reports are divided by age group:
• The less than 6 month old children are only reported for the in-patient facility.
• The 6-59 month old children are reported as a separate category in both reports (OTP and IPF).
188 Although the definition of wasting has changed with the change from NCHS to WHO standards, the definition of
oedema has not changed. The aetiology, seasonality, prevalence and geographic distribution of oedema and wasting are
quite different. There is no “pre-kwashiorkor” condition; although supplementary feeding of MAM children can prevent
deterioration to SAM, supplementary feeding will NOT prevent or change the incidence of kwashiorkor. It is thus very
important to differentiate these conditions in the statistical reports.