guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 127
• The transfer rate from OTP to IPF will vary with the severity of the cases that are identified (if the
triage criteria are being appropriately applied). This will vary with season, the security situation
and be higher at the start of the programme than later on when children are being identified in the
community at an early stage. It will be related to the quality and completeness of the screening
programme. Because it is expected to vary from time to time and situation to situation there is not
a “standard” transfer rate that is to be achieved. Staff should not attempt to keep the transfer rate
as low as possible; each child should have the treatment appropriate for that child 200 .
• The defaulter rate from both OTP and IPF will be low. If this is not the case then a complete
evaluation of the programme needs to be undertaken; the community is not satisfied with the
functioning of the programme.
• There will be no patients in OTP who are discharged with a non-response-to-treatment outcome as
they should be referred to inpatient facility for further investigations.
• The “unknown” outcome will remain low if there is an adequate outreach, community mobilisation,
follow-up and communication between the arms of the programme.
Indicators for each in-patient facility.
The following rates 201 are calculated for each in-patient facility 202 . NOTE that the definitions are not the
same for the IPF and the OTP.
IPF Success rate 203 : The children included in this rate are not counted in the overall programme
performance, but are used for evaluating the IPF against international performance standards. The
success-rate of an IPF is used instead of the “cure rate”, but its meaning is almost the same as most
deaths occur shortly after admission.
Number of patients transferred to OTP (transfer-out plus return)
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Total number of patients leaving the IPF 204
IPF Success rate (for < 6month old children):
Number of infants discharged gaining weight on breast milk alone
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Total number of infants leaving the IPF
200 At the beginning of a programme. where there is no active screening and in famine or very severe circumstances the
transfer rate should be relatively high; in well run stable programmes with active screening in the community the transfer
rate may be much lower. It is also expected that the transfer rate will vary with season, the reputation of the IPF and the
numbers of patients that refuse transfer. In practice the transfer rate varies from 10% to 50% of new patients seen in OTP. If
there is a very low transfer rate, it is likely that the triage procedure is not being properly applied (e.g. the appetite test) and
the teams should be retrained.
201 These are not « rates » in the sense of the number of events occurring in a set period of time, although the reporting
period is standardised to one month. Rather they are proportions or percentages over that period. However, the term « rate »
is retained because it has traditionally been used in this context.
202 Wrong admissions are excluded from all calculations.
203 As the patients are transferred to OTP before they are “cured” there is no cure rate for the IPF, on the other hand it is
demoralising for the staff and pejorative to calculate other indices ignoring the success that the IPF has had in treating
children during the acute and transition phase and transferring them successfully to the OTP programme. Therefore the
“success” rate should be calculated for IPFs instead of “cure” rates.
204 Which correspond to total of patients classified as successfully treated and transferred-out or returned to OTP plus those
that defaulted, died, had medical-referral or unknown.