guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM In-patient 60
the night. Because of the absence of staff at night such residential-day-care can be
used in health centres (and hospitals). 24h care is not required for all the in-patients.
• Patients who live or are hosted by family or friends in the immediate neighbourhood of
the facility come each morning and remain in the facility during the day and then return
home at night (non-residential day-care).
For all in-patients, as soon as they regain their appetites they should continue treatment as outpatients,
wherever the caretaker agrees and an out-patient programme is in place. In exceptional
circumstances they can remain in the in-patient/day-care facility for the recovery phase 74 .
There are several ways in which patients with SAM can be admitted for in-patient care:
• New admissions
• Children who come spontaneously to the hospital/ in-patient facility because of another illness
(such as diarrhoea, pneumonia, malaria etc.) and are found to be severely malnourished on
screening or clinical examination.
• Children who come to the hospital because the caretaker or a community volunteer recognises
that they have severe malnutrition
• Children who are screened at the hospital/outpatient/emergency departments and found to be
severely malnourished. These children should be given an appetite test and IMCI examination
according to the triage procedures. If they have a good appetite they should be referred to OTP
instead of being admitted.
• Children referred to the in-patient facility by a health centre because they fulfil the criteria of
admission to in-patient care (and have not been admitted to the IMAM programme).
• Malnourished Infants less than 6 months old (see separate section).
• Malnourished children of more than 6 months, but less than 3 kg (see separate section)
• These children are NEW admissions and will be given a SAM-number and registered.
• Transfer-In from OTP
• These children have already been under treatment in OTP but have failed their appetite test, have
a complication or have failed to respond to treatment and fulfil the criteria to be transferred to inpatient
care
These children should already have a SAM-number and a transfer-form giving all the information on
the treatment received in OTP. They are NOT new admissions to the programme but “Transfers-in”. A
transfer form (and a phone call) should have been sent with the patient – the transfer form is attached
to the multi-chart. 75
74 This applies to children that are abandoned by their families, where the home circumstances are impossible, where there is
no caretaker or the caretaker is incapable of managing the patient and there is no alternative caretaker. They remain until a
“place of safety” (other relative found, foster care, orphanage etc.) place is arranged. As soon as a placement is arranged the
fostering family or orphanage apply OTP treatment. Children less than 6 months and < 3 kg have a separate protocol.
75 ACF recommendation: The structure which referred the child should be kept informed of the admission of this child in the
in-patient facility.