PART C.

Bilateral Pitting Oedema, MUAC, and WFH/WFL Z-Score

Child Se Age (in Bilatera MUAC Height Weight WFH Z- Classificatio

Name x years l (mm or (cm) (kg) Score
unless Pitting colour) n
noted) Oedem
a
Child 1 F 3 Gree 98.2 12.5 Moderate
n < -1 and

> -2
Child 2 M 5 123 110. 14.8 < -2 and Moderate
0 > -3

Child 3 M 5 ++ Yellow 102.2 13.5 < -2 and Severe

> -3 (bilateral
pitting
oedema)

Child 4 F 4 115 91.1 9.3 < -3 Severe (WFH)

Child 5 M 9 125 69.9 6.7 < -2 and Moderate

month > -3
s

Child 6 F 4 +++ Yellow 105.2 18 > Severe

median (bilateral
pitting
oedema)
Child 7 F 8 + 105 68.2 5.0 < -3 Severe
months (marasmic
kwashiorkor)
Child 8 M 1 Red 84.3 8.9 = -3 z Severe (MUAC)
Child 9 F 2 114 97.2 11 < -2 and Severe (MUAC)
> -3

Child M 1.5 + Green 89.7 12.9 = Severe

10 median (bilateral
pitting
oedema)
What is outpatient care? What does it entail?
2. Who receives outpatient care?
3. How does outpatient care for SAM without medical complications differ from inpatient care for SAM
with medical complications?
PRACTICE: ROUTINE MEDICAL TREATMENT OF SAM. Ask participants to form groups of three.
On a flip chart, write the basic information of a number of children in outpatient care (below). Ask
participants to determine which medications and dosages each child needs based on whether the child is
a new case, what medication s/he has already received, his/her medical condition, and his/her age.

▪ Patient 1: Girl, age 2 years

 Referred from inpatient care after 10 days of stabilisation of medical complications, which
included eye signs of vitamin A deficiency. The girl is now clinically well, has a good appetite, and
received two doses of vitamin A on Day 1 and 2 of inpatient care for the treatment of vitamin A
deficiency. It has been 5 days since she was discharged from inpatient care.
 Bilateral pitting oedema: Grade +
 Paracheck: Negative
 Vaccination record: All up to date
 Vitamin A: Day 1 and 2 of inpatient care

Answer: Give amoxicillin 3 times per day for 7 days; do not give malaria treatment; do not give
measles vaccination (given after 4 weeks). Give the third dose of vitamin A (on day 15) to complete
the treatment of eye signs.

▪ Patient 2: Boy, age 18 months

 New admission
 Bilateral pitting oedema: No
 Paracheck: Positive
 Vaccination record: Incomplete
 Vitamin A last given: 6 months ago

Answer: Give amoxicillin 3 times per day for 7 days; give malaria treatment according to protocol;
give measles vaccination on week four or as soon as possible, plus other vaccines as per expanded
programme of immunisation (EPI); do not give vitamin A because it is already in the RUTF.

▪ Patient 3: Girl, 15 months

 Second visit to outpatient care
 Bilateral pitting oedema: grade +
 Paracheck: Negative
 Vaccination record: Incomplete
 Vitamin A last given: 4 months ago
 Amoxicillin last given: Week one on admission
Answer: Give medendazole or other deworming; give measles vaccination on week four as well as
other vaccines as per EPI; do not give malaria treatment; do not give vitamin A because it is already
in the RUTF.

RUTF RATION PRACTICE.

Example 1: 92 g packets of RUTF are distributed through outpatient care. Child 1 weighs 6.8 kg and
comes to outpatient care every two weeks. How much RUTF do you give the child? (Answer: 36 packets)
Example 2: Child 3 weighs 7.2 kg and will return to outpatient care next week. How many packets of
your locally produced RUTF will you give the child? (Answer: 18 packets)
Exercise 4.3 Identifying Infants Under 6 Months and Children 6–59 Months Who
May Need Referral to Inpatient Care or Follow-Up Home Visits (with answers)