guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 130
OTP Unknown outcome rate
This is where the outcome of the patient is not known – the patient has either defaulted or died. The
staff should not consider that an unknown outcome is a reason for criticism. It is usually not possible to
determine if a child is a defaulter or has died between time of absence of the child and preparing the
monthly report – there is provision for revision of the categories of discharged patients from previous
months when a home-visit has been made by the outreach worker or community volunteer. If there is
no home-visit then the child will remain in the unknown outcome category. This category will either be
added to the defaulter rate to give the true defaulter rate or to the death rate to give the true death
rate; until the outcome is determined the unknown rate will result in a possible range for the defaulters
and for the deaths.
Number of patients absent from the programme whose outcome is unknown
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Total of patients classified as cured, default, unknown and died
OTP Transfer-out rate is the proportion of the children that are transferred to an IPF or another OTP.
Number of patient transferred to IPF or another OTP
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Total of patients transferred-out plus those classified as cured, default, unknown and died
There are other rates that are used to evaluate the programme that can be calculated by the District
Nutrition officer from the reports. See below to consolidated report:
OTP Mean length of stay (wasted cured children)
This indicator should be calculated ONLY for the cured patients 212 aged 6 to 59 months.
Sum of number of days for each recovered patient (discharge date – admission date both included)
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Number of recovered patients
Mean rate of weight gain (RWGmin) for wasted cured children (OTP only)
This indicator is particularly useful to show the quality of feeding at home. It is related to the degree of
sharing of the RUTF within the family. The average weight gain is calculated for all RECOVERED
patients from 6 to 59 months of age.
1. The rate of weight gain for an individual is calculated as the discharge weight minus the minimum
weight multiplied by 1000 to convert the weight gain to grams.
2. This is then divided by the minimum weight to give grams of weight gained per kilo body weight.
Lastly, this total weight gain is divided by the number of days from the day of minimum weight to the
day of discharge, to give g/kg/d. The Average rate of weight gain is then 213 :
212 The mean length of stay for other patients can be useful information: thus the average time that the dead patients were in
the programme before death and the average time of defaulting can give an indication of where effort needs to be focused to
lower these rates. However, as there is usually considerable variation and the data are highly skewed, this information is
more usefully collected during an occasional evaluation and analysed separately.
213 The date of minimum weight is often not known for OTP patients – the date of the lowest weight recorded on the OTP
chart should be used. Sometimes the rate of weight gain from admission to discharge is used for convenience. If this
method of calculating the rate of weight gain is used, then this should be reported as RWGadm.