Self-Assessment Questions (SAQs) for Study Session 10

Answer

• a.Dawit’s MUAC is in the ‘moderate acute malnutrition’ range because his MUAC is between 11cm and 12cm. Look back at Table 5.3 if you need to remind yourself of the different ranges of MUAC. His weight for height is also in the ‘moderate acute malnutrition’ range because it is between 70% and 80% of what would be the normal weight for an infant of his age. However you would class Dawit as having ‘severe acute malnutrition’ because he has oedema. Any child who fulfils one criterion for severe acute malnutrition (and oedema falls into this category) will be classified as having severe acute malnutrition.
• b.Because Dawit is six months old, he does not automatically need to be referred to an in-patient facility. If Dawit had complications however – such as the presence of general danger signs, pneumonia/severe pneumonia, blood in the stool, fever or hypothermia – his classification will be ‘severe complicated malnutrition’. This means he needs to be referred to an in-patient facility for stabilisation of his clinical condition. Another indicator that would require Dawit to be referred to an in-patient facility would be if he failed the appetite test. You should recall that in the appetite test, there is a minimum amount of food that the child should take for their weight range. For Dawit, because his weight comes in the range of 4 – 10kg, he needs to take ¼ – ½ of a sachet to pass the appetite test. If he does not pass, then he needs to be referred.

Answer

• a.The appetite test is an important indicator of how seriously malnourished a child may be and whether they need to be referred for in-patient care. A child who is unable to take the minimum amount of RUTF required to pass the appetite test should be referred to and receive care from the nearest Therapeutic Feeding Unit or Stabilisation Centre for in-patient management.
• b.If a malnourished child does not need referring to an in-patient facility they can be registered for an Out-patient Therapeutic Programme (OTP). You should explain to Dawit’s family how to help with the OTP treatment and then you would register Dawit in the OTP registration book, and fill out the OTP card which will allow you to build up a record of his treatments and progress.
• c.There are a number of key messages that you can give the parents — compare your answer with the messages in the list below. You may want to write these in your Study Diary to refer to when following up children on an OTP day, as a reminder of the points you want to share with parents.

• Plumpy’nut® (RUTF) is a food and medicine for malnourished children only. It should not be shared
• For breastfed children, the mother should always give breastmilk before the RUTF; she should continue to breastfeed on demand
• RUTF should be given before other foods. The mother or caregiver should give small regular meals of RUTF and encourage the child to eat, every three to four hours
• The child should always be offered plenty of clean water to drink while eating the RUTF
• The mother or caregiver should always use soap and water to wash their hands before feeding the child
• Food should be kept clean and covered
• Sick children get cold quickly, so the child should be kept covered and warm.

Answer

• a.The registration book is used to enable you to prepare monthly reports and analyse the performance of your OTP. You will be able to compare the monthly performance of your health post with other health posts and with the standard that is set at your woreda or regional level. You can also see the trend of mortality rate and/or recovery rate over several months to see if your efforts to improve the quality of the OTP services are bearing fruit.

  The OTP card enables you to follow children efficiently on a weekly basis. You have to record each key indicator for the child and this will help you follow up the child’s progress in the course of the treatment (and remind you which ones you need to check). You should explain to the parents or caregiver the importance of the registration book and OTP card for the management of children in your community who have severe uncomplicated malnutrition, so they know why you are taking this information.

• b.When you make follow-up visits to the home, you will want to see how the malnourished child is progressing. You would ask the parents or caregiver whether the child has had diarrhoea, vomiting, fever or any other new complaint or problem since the last visit. You would also want to ensure that the child is finishing the weekly ration of RUTF. Other indicators you need to look for include whether there are any other complications, the child’s temperature, weight and MUAC. You should also check whether the child has oedema and finally, do the appetite test.

Answer

If a child was admitted to an in-patient facility with oedema on both feet, there needs to be two consecutive visits (14 days) where there is no presence of oedema before the child can be discharged. For a child who was admitted without oedema, the criterion for discharge is when the child reaches its target weight. On discharge from the facility you would need to counsel the mother on feeding and caring for her child at home. If the service exists, you can provide the mother or caregiver with a discharge certificate and make a referral for the child to the supplementary feeding programme.

Answer

There are different ways to ensure that your community is aware of the services available in OTPs. Using formal and informal ways to communicate with people (e.g. talking to respected men and women in your village who other people will listen to, so they can promote awareness of OTP days) will be important. You can also ask kebele administrators and Gott leaders to use their meetings to pass on key messages. Assigning a fixed day in the week as an OTP day will help caregivers to remember the day of their appointment. If you plan ahead and anticipate the stocks you need, based on your caseload, this will help ensure you can provide the best possible treatment and care for managing severe malnutrition in your community.