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HealthPhone™: Exercise 2 - Severe Acute Malnutrition - Assessing, Classifying and Taking Action

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Exercise-2 Assessing, Classifying and Taking Action

Exercise 2-Assessing, Classifying and Taking Action

Almaz Habitu, 24 months old, screened for severe acute malnutrtion and the mid-upper arm circumference measurement was 10.4 centimeters and she has no bi-lateral pitting edema of both feet.

The weight of Almaz measured to be 6.8 kilograms.

If a child fulfills the criteria for severe acute malnutrition then we have to check first for any one of the danger signs and complications before deciding to admit to OTP.

We have to also do an appetite test.

If the child has one of the general danger signs or medical complications, or if they have failed the appetite test, he has to be sent immediately to therapeutic feeding unit.

Now let's examine Almaz look for any one of the general danger signs.

Does Almaz have any history of abnormal body movement in the past or recently? Never.

Almaz doesn't have convulsions? Almaz is alert? And she is not lethargic?

What about vomiting? Not at all.

Is she taking her feed well? Yes.

Does Almaz show any danger signs?

We didn't find any one of the general danger signs.

Almaz doesn't have convulsions, she is conscious, and not lethargic.

She has no vomiting and she is feeding well.

Therefore, Almaz doesn't have any one of the general danger signs.

Now, let's examine Almaz look for any signs or complications.

Let's count respiratory rate and check for chest in-drawing.

Did you see chest in-drawing?

Respiratory rate of Almaz is 36, which means she doesn't have fast breathing, and she doesn't have chest in-drawing.

Therefore, Almaz doesn't have signs of pneumonia, or severe pneumonia.

Does she have diarrhea?

She was having watery diarrhea three to four times per day for a month but the diarrhea has stopped in the last two weeks.

Does she have blood in the stool? No.

Does she have a fever? No.

The health extension worker measures the temperature and it is 37.2 degrees.

Almaz doesn't have any pneumonia or severe pneumonia dysentry, fever, or low body temperature.

Therefore, she doesn't have any signs of complications.

Almaz doesn't have any of the general danger signs and has no medical complications as well.

What additional things do we need to decide to admit Almaz to OTP?

Appetite test should be done first to decide admission to the OTP after checking for general danger signs and complications.

Appetite tests help to detect the presence of severe infections or metabolic abnormalities.

Almaz is 6.8 kilograms. How much ready-to-use therapeutic food does she have to take to pass the appetite test? Please refer to the appetite test table on your reference page 16.

Almaz is 6.8 kilograms and she should finish a quarter to half a sachet of ready-to-use- therapeutic food to pass the appetite test.

Almaz has finished half of the ready-to-use food within thirty minutes.

Therefore, she has passed the appetite test.

Can Almaz be managed at the OTP in the health post?

What is your decision?

Almaz is more than six months old her mid-upper arm circumference measurement is less than 11 centimeters and has no general danger signs pneumonia, dysentry, fever or hyperthermia.

She has also passed the appetite test. Therefore, she will be classified as uncomplicated severe acute malnutrition the yellow shaded category and she doesn't need any referral and can be managed at health post using the OTP protocol.

Discharge Criteria

Decision on discharge

Almaz was admitted to the OTP program five weeks ago.

Her appetite has improved very well and she has no complaints during her stay at OTP.

Almaz was 6.8 kilograms when she first joined the program.

She has gained weight progressively.

Almaz has no cough, diarrhea, blood in the stool, and fever.

The health extension worker has checked for pitting edema of both feet by applying thumb pressure on both feet, for three seconds and she could not see the shallow print.

The weight is taken and it is 7.8 kilograms.

Respiratory rate is 40 per minute and temperature is 36.9 degrees Celsius.

Almaz is provided with ready-to-use therapeutic foods and she eats them well.

What action would you take on this visit?

What is the target weight of Almaz?

For severe acute malnutrition cases that were admitted without edema they will be discharged when the patient reaches discharge target weight.

Almaz's target weight is 7.8 kilograms and she can be discharged today.

Record the data on the OTP card and the outcome section should be filled as 'cured'.

Enter the data to the OTP register as well.

Counsel on nutrition.

Give discharge certificate and refer to the targeted supplementary feeding if available in the area.

Anone Kette, 14 months old child was first admitted to the OTP program four weeks ago after he had developed bi-lateral pitted swelling on both his legs and feet.

His mother, Fatima, was dedicated and was bringing Anone on a weekly basis to the OTP as per her appointments.

The swelling on both his legs and feet disappeared on the second week.

Today, Anone has no cough, vomiting, or diarrhea, or blood in the stool.

He is finishing the daily prescribed ready-to-use therapeutic food and starts to take additional food.

He has no pitted edema of both feet and also the weight is 12.8 kilograms.

He has no danger signs.

Respiratory rate is 32 per minute and the temperature equals 37 degrees Celsius.

Anone was on the OTP for the last four weeks and today is his fifth week.

The edema disappeared on the second week.

What action will you take today?

Children who were admitted to OTP based on edema they have to be discharged if there is no edema for two consecutive visits-14 days.

The legs and feet edema of Anone has cleared on the second week and it was followed by two consecutive weeks and is still absent.

Therefore, we decided to discharge Anone from OTP and he will be referred to targeted supplementary food program.

Record the data on the OTP card and the outcome section should be filled as 'cured.' Enter the data to the OTP register as well.

Counsel on nutrition give discharge certificate and refer to the targeted supplementary feeding, if available in the area.

Director Sintayenu Niguse

Camera Efrata Belachew Natanaeal Belachew

Sound Sami Kemal

Narration Indrias Getachew

Editors Markos G/tsadik Mehari G/mariam Yonas Kiros

Acknowledgements Dr. Ibrahim Abdella, Dr. Tewoldebrhan Daniel, Ato Antenanie Enyew Dr. Assaye Kassaye, Dr. Habtamu Fekadu, Dr. Anwar Yibre, Ato Samson Desie Ato Mesfin Mekonnen, Ms. Sylvie Chamois, Ato Indrias Getachew Alaba Special Woreda Community, Alaba Special Woreda Health Office, Alaba Center Health Workers Huletegna Konecha Health Post Health Extension Workers, Huletegna Konecha Community Volunteer Health Workers Ms. Tayech Mola Health Extension Worker, Samaritan Purse International

Video Details

Duration: 8 minutes and 43 seconds
Year: 2009
Country: Ethiopia
Language: English
Producer: Federal Ministry of Health and UNICEF, Ethiopia
Views: 979
Posted by: nand on Feb 11, 2012

Intended for Health Extension Workers (HEW) on how to do screening for malnutrition, how to identify Severe Acute Malnutrition cases; and how to conduct Out-Patient Therapeutic Programme for SAM in order to maximize the coverage and improve the quality of services provided to SAM cases at the community level.

Management of Severe Acute Malnutrition and Out Patient Therapeutic Program Training Material - Federal Ministry of Health and UNICEF, Ethiopia

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