guidelines for the integrated management of severe acute malnutrition

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ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 132 � In producing the overall programme statistics the transfer-out and transfer-in categories are not used. The numbers of NEW admissions plus the relapses for all the OTPs and the IPF are added together to give the total admissions for the programme within the catchment area 214 ; the number of cures, deaths, defaulting, unknown and medical referrals are also summed over each OTP and IPF and then the overall rates are calculated. • Programme cure rate = Number of patients cured /Total number of exits from the programme • Programme default rate = Number of patients defaulting /Total number of exits from the programme • Programme death rate = Number of patients who died /Total number of exits from the programme • Programme unknown outcome rate = Number of patients with unknown outcome/Total number of exits from the programme • Programme medical-referral rate = Number of patients leaving because of medical referral /Total number of exits from the programme � The total number of exits from the programme = the sum of all the children who were cured, died, defaulted, were absent with unknown outcome and medical-referrals. (Remember that it doesn’t include the transfer-out and transfer-in categories.) � The transfer-out from the OTPs to the IPF should match the transfer-in to the IPF. Where the IPF lists the referring OTP sites separately in its report for admissions and discharges it is possible to examine the numbers of patients who fail to reach the destination facility. � The village screening data are also compiled by the District Health Management team with the Nutrition Office and the statistics, health information and rural development focal points. The data should be mapped to show the pockets of malnutrition act and analysed by month to show any seasonality. This functions as a surveillance system, indicates where new OTP or IPF facilities are to be sited and defines a “normal” year so that future deviations may indicate an emergency situation. The numbers of children identified in the catchment area of an OTP as having SAM from screening should match the numbers of new admissions to the OTP. If this is not the case, the reason should be sought; often this is related to the distance the patients have to travel and indicates the need for opening a new OTP site. � There are several other indicators that the District Health team members/District Nutrition officer should compile from time to time. These would include: • The refusal-to-be-transferred rate • The death during transport rate (dead-on-arrival) Which would both indicate the need for a new IPF (perhaps in a health centre) to be established close to the patients’ homes. • Wrong referral rate by the screening teams to the OTPs. (Indicates need for retraining of screening teams) • The wrong admission rate to the OTP and IPF (indicates need for retraining of OTP/IPF staff). 214 Do NOT take the average of the rates. Do take the absolute number of children from each OTP and IPF that is new admissions or discharges. Each will have a different number of patients so that an average is biased that is why it is important to add the numbers together and then calculate the overall rate of cure, defaulting, death, medical referral, and unknown outcome.
ACF-In Guidelines for the integrated management of SAM Monitoring and evaluation 133 5. Minimum standards Reference values have been developed by the Sphere project. They provide benchmarks against which to interpret the functioning of individual in-patient programmes. They give an indication of what might be considered “acceptable” and “bad” functioning under average conditions. In the last Sphere standards project handbook of April 2011, it is stated that: “Performance indicators relate to discharged individuals ending treatment. The total number of discharged individuals is made up of all who have recovered, died, defaulted or are nonrecovered. Individuals who are referred for complementary services (such as health services) have not ended the treatment and will either continue treatment or return to continue the treatment later. Individuals transferred out to other sites have not ended the treatment and should not be included in performance indicators. Performance-related indicators are as follows: • Proportion of discharged recovered= (Number of individuals recovered / total number of discharged)*100 % • Proportion of discharged died= (Number of individuals died / total number of discharged)*100 % • Proportion of discharged defaulted= (Number of individuals defaulted / total number of discharged)*100 % • Proportion of discharged non-recovered= (Number of individuals non-recovered / total number of discharged)*100 % → Key indicators (to be read in conjunction with the guidance notes). These indicators are primarily applicable to the 6–59 month age group, although others may be part of the programme. The proportion of discharges from therapeutic care who have: • died is 75 %, • defaulted is
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Page 181 and 182: Cover photography: © ACF, Anne-Dom
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guidelines for the integrated management of severe acute malnutrition

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