guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 121
• Others would include all SAM patients over the age of 59 months 189 .
Type of admission to an OTP
“New admission”: This is where a patient has not been under treatment elsewhere – such patients
are either referred from the community screening programme or spontaneously come to the OTP
seeking treatment. They do not have a SAM number and one should be assigned 190 .
“Relapse”: This is where a child has been in the programme – IPF, OTP or both – and has been
discharged from the programme as cured. The same child is now severely malnourished again and is
admitted. The child is given his/her original SAM number, but there is a hyphen after the main number
with a number denoting the number of episodes of severe malnutrition that the child has had. Thus, if
the child with the SAM number is discharged cured and is then readmitted to the
programme after 7 months, this child is assigned the number < OTPNaj/0001-2>. If the original SAM-
No cannot be found a new SAM-No should be given, but it should always have xxx-2 to denote a
second admission to the programme. Children that have relapsed are particularly vulnerable and the
fact that they are relapses should be noted in the Major problem section of their charts. The algorithm
for failure-to-respond to treatment should be followed. There should be a home visit to determine if
there is a social problem causing the relapse. They usually need to be seen as in-patients and a
search made for underlying illness. This is considered as a new admission – although the SAM
number is basically the same as for the previous admission, the “-2” at the end indicates that this is a
new admission.
“Transfer-in”
• “Transfer-in” to an OTP from another OTP. This is where a patient is transferred from one OTP to
another OTP; it is NOT a new admission (to the programme for treatment of SAM) and the child
should already have a SAM number.
• “Transfer-in” to an OTP from an In-Patient facility. This is where a patient is transferred from the Inpatient
facility; it is NOT counted as a new admission as the patient has been under care in the Inpatient
facility; the child should already have a SAM number, which will be used by the OTP.
“Return” from In-Patient care to OTP. This is where a patient has been sent from the OTP for Inpatient
care. The child has already been admitted as a new patient to an OTP, has then been sent for
In-Patient care and now returned to his/her original referring OTP.
“Readmission”: This is where a defaulter returns to either the OTP or in-patient facility to resume
treatment after an absence of 2 months or less. The child is not a new admission and is reassigned
his/her original SAM-number.
Types of discharge and transfer from OTP
“Cured”: A patient reaching the criteria for discharge is called “cured”. Discharge to the
Supplementary Feeding Programme (SFP) is not considered as a transfer, but as a discharge from the
189 The data are not normally broken down by sex if unisex criteria are used for admission; analysis of over 10,000
admissions using unisex (NCHS) criteria show that approximately equal numbers of boys and girls are admitted and their
outcome is not different. The WHO tables discriminate against girls; if sex specific tables are used for admission criteria
then the data should also be reported by sex. Other categories are not routinely reported. Occasionally separate studies
are made on a sample to examine other age categories, pregnant or lactating women, special cases (e.g. disabled, twins, and
orphans).
190 During periodic evaluations the number and outcome of screened and referred patients should be compared with the
spontaneous admissions. The spontaneous admissions have a tendency to be more severely ill and at higher risk of death,
this should affect the proportion of admissions that are transferred to in-patient care for the acute phase.