guidelines for the integrated management of severe acute malnutrition

ACF-In Guidelines for the integrated management of SAM In-patient: Failure to respond to treatment 98
FAILURE TO RESPOND to treatment (in-patients)
It is usually only when children fulfil the criteria for “failure-to-respond” that they need to have an
extensive history and examination or laboratory investigations conducted. Most patients are managed
by less highly trained staff (adequately supervised) on a routine basis. Skilled staff (nurses and
doctors) time and resources should be mainly directed to those few children who fail-to-respond to the
standard treatment.
Failure-to-respond to standard treatment is a “diagnosis” in its own right. It should be recorded on the
chart as such and the child then seen by more senior and experienced staff. For out-patients (see
separate section on failure to respond) the most common reason for failure is a social problem,
although social and psychological reasons can be the case with in-patient care, it is much less likely.
In-Patients
Table 15: Failure to respond for In-Patients
Criteria for failure to respond Time after admission
Primary failure to respond (acute-phase)
Failure to improve/regain appetite Day 4
Failure to start to lose oedema Day 4
Oedema still present Day 10
Failure to fulfil the criteria for recovery-phase (OTP) Day 10
Secondary failure to respond
Deterioration after admission in the acute phase At any time
Note that the day of admission is counted as day 0, so that day 1 is the day after admission [115] 157 .
Usual causes of failure to respond:
Problems with the treatment facility:
� Failure to apply the protocol appropriately
� Poor environment for malnourished children
� Excessively intimidating, strict or cross staff
� Failure to treat the children in a separate area
� Failure to complete the multi-chart correctly
� Insufficient staff (particularly at night)
� poorly trained staff
� Inaccurate weighing machines
� F75 not prepared or given correctly
Problems of individual children:
157 It is common practice to call the day of admission day 1; this makes date subtraction on the computer incorrect by one
day. In fact the day of admission can be anywhere between 0 and 24h. Like other periods of time – for example age – the
length of stay etc is measured in completed days.