guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM Out-patient 50
Primary failure to respond (acute-phase)
Failure to gain any weight (non-oedematous children) 21 days
Weight loss since admission to programme (non-oedematous children) 14 days
Failure to start to lose oedema 14 days
Oedema still present 21 days
Secondary failure to respond
Failure of Appetite test At any visit
Weight loss of 5% of body weight (see table annex 13) At any visit
Weight loss for two successive visits During OTP care
Failure to start to gain weight satisfactorily (about 1.5% body weight per week)
after loss of oedema (kwashiorkor) or from day 14 (marasmus) onwards.
Problems with the OTP:
Usual causes of failure to respond are:
� Inappropriate selection of patients to go directly to OTP
During OTP care
� Poorly conducted appetite test or appetite “judged” by inexperienced personnel and not
measured.
� Inadequate instructions given to caretakers (especially with respect to sharing within the family)
� Wrong amounts of RUTF dispensed to children
� Excessive time between OTP distributions (e.g. two weekly gives significantly worse results
than weekly visits)
Problems of individual children - social:
� Insufficient RUTF given by caretaker
� RUTF taken by siblings or caretaker
� Sibling rivalry (food as well as RUTF taken by older children)
� All eating from the same plate (the malnourished child should always have his/her own portion
of food).
� Excessive intake of other foods of poor quality from family pot or traditional weaning
foods/paps.
� Unwilling caretaker
� Caretaker overwhelmed with other work, responsibilities or illness.
� Death of caretaker or major change in family circumstances
� Purposeful discrimination against the child.
� Use of the child’s illness to access relief or other services for the family or to ensure the child
remains within the programme
Problems of individual children - psychological