guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 126
7. The charts and registration book contain all the information needed to analyse and report the
results of the in-patient programme in a standard way.
4. Quantitative indicators
Statistics are obtained directly from the registration books (or, alternatively, from individual multi-charts
where it is thought that there is a discrepancy or special analyses are to be undertaken: the multicharts
should be filed together sequentially (in order of the facility registration number) and separately
from the general hospital records; the records for the children who die should not be separated and
filed separately from those that have other outcomes).
Monthly statistics report for In and Out Patients (see annex 14)
The monthly reports are slightly different for in-patients and out-patients.
The data should be reported and indicators calculated for infants less than 6 months (in-patients),
children from 6 to 59months and those above 5 years of age (both in an out patients) separately 199 .
� In a fully integrated programme, the analysis of the in-patient report should also be broken in
terms of each OTP that transfers patients to the in-patient facility. This allows the District
Nutrition officer, who will produce the consolidated report, to compare the numbers of children
transferred-out of the OTP to the IPF with the number that arrived from that OTP site; and the
number of children transferred-out from the IPF who arrived at the satellite OTP.
� The number of children actively in the programme at any one site at the end of the previous
month should agree with the number in the programme at the start of the subsequent month.
The difference in the SAM numbers of the last newly admitted patient from one month to the next
should tally with the number of new admissions reported. The total admissions minus the
discharges should agree with the change in the number of patients in the programme.
� As nearly all of the patients in the in-patient facility are transferred to OTP once the acute and
transition phases are over, virtually none of those leaving the IPF are fully recovered or “cured”,
this leads to the “cure rate” calculated in the IPF to be very low; the staff then designate all their
transfers to OTP as “cured”, when this is not the case. Thus, for the IPF a new indicator is
appropriate designated “success-rate”. If an in-patient successfully passes through the acute
and transition phase in the IPF, this is a successful outcome of the time spent as an in-inpatient.
� It is necessary to consolidate all the OTP and IPF reports together for a single catchment area to
get precise data on the total numbers of children treated for SAM and for the death, defaulting
and cure rates.
On the other hand, it is important to have the reports from each OTP and IPF separately. This is
necessary to both arrange re-stocking of consumable supplies (RUTF, antibiotics, charts, etc)
and also to identify the geographical areas where the major case load arises, how ill the children
are in those areas (death rate, transfer-out rate) and the functioning of the individual OTP.
It is expected that:
• Nearly all deaths will occur in the in-patient facility; the OTP will have a very low death rate
because they should transfer all the high-risk children to the in-patient facility. If this is not the case
then there is a problem with triage, transport or the reputation of the IPF with the community (so
that there are many refusals to go to the IPF). To get a proper picture of the functioning of the
programme the IPF data have to be integrated with the OTP data.
199 The data are not usually broken down by sex. At least once per year a sample of new admissions should be taken and the
gender ratio calculated for the various indicators in the monthly report.