8.2  The out-patient therapeutic programme (OTP)

An OTP is a programme that provides home-based treatment and rehabilitation for children with severe uncomplicated malnutrition. These children can be admitted directly into an OTP, treated with routine drugs, and as you read in the previous study session, given ready-to-use therapeutic food (RUTF) to eat at home. The children attend the OTP every week for a medical check-up, receive additional medical treatments if required and are given a one-week supply of RUTF. Box 8.1 below describes RUTF.

Box 8.1  Ready-to-use food (RUTF)

RUTF is therapeutic food that can be consumed easily by children straight from the packet or pot without any cooking. It is a high-energy, nutrient-dense food. It is easy to use and store. It can be kept in simple packaging for several months without refrigeration. It can be kept for several days even when opened.

BP-100® and Plumpy’nut® are the commonly known RUTF preparations. If you have both products available, you should give children under two years of age either Plumpy’nut, or crush BP-100 and make this into porridge for the child. Children above the age of two years can take the BP-100 biscuit and you may not need to make porridge. The amount of RUTF that should be given to severely malnourished children is based on their weight as indicated in Table 8.2 below.

Table 8.2  RUTF amounts based on weight of child.
Class of weight (kg)PLUMPY’NUT®BP-100®
sachet per daysachet per weekbars per daybars per week

Box 8.2 below summarises the key messages for mothers and caregivers of children admitted to an OTP.

Box 8.2  Key messages for caregivers of children in OTP

  • RUTF is a food and medicine for malnourished children only. It should not be shared.
  • For breastfed children, breastmilk should always be given before the RUTF and on demand.
  • RUTF should be given before other foods. The child should have small regular meals of RUTF and be encouraged to eat often, every three to four hours.
  • Plenty of clean water to drink should always be offered to the child when he or she is eating RUTF.
  • The caregiver should wash their hands with soap and water before feeding the child.
  • Food must be kept clean and covered.
  • A sick child gets cold quickly so should be kept covered and warm.

A child with severe uncomplicated malnutrition should also receive routine drugs. These drugs are very important for the child to recover quickly. Table 8.3 sets out what routine medicines should be given to severely malnourished children and the correct dosage according to their age and previous treatment history.

Table 8.3  Routine medicines for severely malnourished infants and children.
Vitamin A1 dose at admission for all children except those with oedema or those who received vitamin A in the past six months
Folic acid1 dose at admission

1 dose at admission + give treatment for seven days to take home.

The first dose should be given in the presence of the supervisor

Deworming1 dose on the second week (second visit)

Measles vaccine (from nine months old)

1 vaccine dose on the fourth week (fourth visit)

The following four tables refer specifically to vitamin A, folic acid and Amoxicillin and show what dose should be given to severely malnourished children and when.

Table 8.4  Vitamin A.
Age in monthsVitamin A IU orally
6–11One blue capsule (100,000 IU)
12 (or 8 kg) and moreTwo blue capsules (200,000 IU)
Table 8.5  Folic acid.

At admission

5 mg

Table 8.6  Amoxicillin.
Weight in kgDosage twice per day250 mg capsule/tablet
125 mg½
5‒10250 mg1
10‒20500 mg2
20‒35750 mg3
>351000 mg4
Table 8.7  Deworming drugs.
Age up to 2 years
Albendazole 400 mg1 tablet once
Mebendazole 100 mg5 tablets once

8.1.7  Treatment when there is no anaemia

8.3  Follow-up care of the child with malnutrition and anaemia