8.3.1  Follow-up care for severe malnutrition

Follow-up care for a child assessed as having severe malnutrition is an important part of the OTP and the mother or caregiver should be advised to come to the health post every week for two months, so that follow-up care can be provided.

You should remember that the mother or caregiver may be feeling very anxious about her child’s health. Ask questions and praise the mother when she tells you about the positive things she is doing to help the child. You can base your assessment of the child’s progress on a number of signs and these are set out in Box 8.3 below.

Box 8.3  Checklist for follow-up of a child with severe uncomplicated malnutrition

Follow-up should be done every seven days for at least two months as follows:

Ask about

  • Diarrhoea, vomiting, fever or any other new complaint or problem
  • Whether the child is finishing their weekly RUTF ration.

Check for

  • Complications
  • Temperature, respiration rate
  • Weight, MUAC and oedema
  • Appetite (do the appetite test).

Decide on action

Refer if there is any one of the following:

  • Development of any new complication
  • Failed appetite test
  • Increase/development of oedema
  • Weight loss for two consecutive visits
  • Failure to gain weight for three consecutive visits
  • Major illness or death of the main caregiver so that the child can’t be managed at home.

If there is no indication for referral, give:

  • De-worming and measles vaccination
  • Weekly ration of Plumpy’nut® or BP-100®
  • Appointment for next follow-up and record the information on the OTP card.

If the child is absent for any follow-up visit:

  • Ask the community volunteer to do a home visit and report back to you as the Health Extension Practitioner.


A child stays in the programme until they meets the discharge criteria or have been in the programme for a maximum of two months. The discharge criteria depend on the admission criteria.

  • For those who were admitted based on oedema: discharge if there is no oedema for two consecutive visits (14 days)
  • For those who were admitted without oedema: discharge when the child reaches the discharge target weight (as indicated in your chart booklet).

The child who fails to reach the discharge criteria after two months of OTP treatment, must always be referred to a hospital.

On discharge make sure:

  • Counselling on child feeding and care is given to the mother or caregiver
  • A discharge certificate is given to the mother or caregiver and referral to the Supplementary Feeding Programme is made (whenever one is available)
  • A child is registered appropriately in the registration book on date of discharge.

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

8.3.2  Follow-up care for moderate acute malnutrition