SOS OTP and TSFP TRAINING

PRESENTER: Mr.Abdikadir Shekh Hussein

TELL:0618325989/0613080843/0615961264
EMAIL:nationaltcc01@gmail.com
Email:Abdikadiryusuf1010@gmail.com
 Objectives of the workshop

◦ To improve the quality of care provided to the

beneficiaries in OTP and TSFP

 Expected results of the workshop

• Each participant will have acquired the minimum knowledge for
improved care practices in OTP and TSFP
• Each participant will have understood the needs for a holistic approach
in integrated management of acute malnutrition
Overview Malnutrition
Overview of Integrated Management of Acute Malnutrition
(IMAM)
 Nutrition’s contributions to the attainment of the MDGs
Goal 1: Eradicate extreme poverty and Malnutrition erodes human capital, reduces resilience to
hunger
Goal 2: Achieve universal primary
education
Goal 3: Promote gender equality and
empower women
Goal 4: Reduce child mortality
Goal 5: Improve maternal health
Goal 6: Combat HIV/AIDS, malaria,
and other diseases
shocks and reduces productivity (impaired physical and
mental capacity).
Malnutrition reduces mental capacity. Malnourished
children are less likely to enroll in school, or more likely t
enroll
later. Current hunger and malnutrition reduces school
performance.
Better-nourished girls are more likely to stay in school and
to have more control over future choices.
Malnutrition is directly or indirectly associated with more
than 50% of all child mortality. Malnutrition is the main
contributor to the burden of disease in the developing wor
Maternal health is compromised by an anti-female bias in
allocations of food, health and care. Malnutrition is
associated with most major risk factors for maternal
mortality.
Malnutrition hastens onset of AIDS among HIV-positive.
Malnutrition weakens resistance to infections and reduces
malarial survival rates.
 Acronym
 CMAM Community-Based Management of Acute Malnutrition
 IMAM Integrated Management of Acute Malnutrition
 GAM Global Acute Malnutrition
 SAM Severe Acute Malnutrition
 MAM Moderate Acute Malnutrition
 WFH Weight for Height
 WFA Weight for Age
 HFA Height for Age
 MUAC Mid Upper Arm Circumference
 CSB Corn Soy Blend
 FBF Fortified Blended Food
 IYCF Infant and Young Child Feeding
 NCHS national Centre for Health Statistics
 SFC Supplementary Feeding Centre
 NRU Nutritional Rehabilitation Unit
 TFC Therapeutic Feeding Centre
 OTP Outpatient Therapeutic Program
 SC Stabilization Care
 ReSoMal Rehydration Solution for Malnutrition
 RUTF Ready to Use Therapeutic Food
Recent History in the Management of Severe Acute Malnutrition (SAM)

 Traditionally, children with SAM are treated in centre-based

care: paediatric ward, therapeutic feeding centre (TFC), nutrition
rehabilitation unit (NRU), other inpatient care sites. (This
approach greatly limits coverage and impact)
 The centre-based care model follows the World Health
Organization (WHO) Guidelines for Management of Severe
Malnutrition.
 In 2001 CTC (Community Based Therapeutic Care) approach
was introduced in emergency situations. (Resulted in dramatic
increase of program coverage and number of children
successfully treated.
 Community Based Management of Acute Malnutrition (CMAM)
evolved from CTC.
Centre-Based Care for Children with SAM: Challenges

Low coverage leading to late presentation

Overcrowding
Heavy staff work loads
Cross infection
High default rates due to need for long stay
Potential for mothers to engage in high risk
behaviours to cover meals
IMAM?
 Community based public health approach to treating
malnutrition
 Benefits at individual & population level
 Improves access to care
 Close liaison with community improves case
coverage (proportion of diseased subjects receiving
care)
 Reduces opportunity costs to family
 Supports family coping mechanisms and /or family
unit
IMAM
 A community-based approach to treating SAM
◦ IMAM helps identify SAM in the community before the onset
of complications (Screening in Community through
LHWs/CHWs/ Volunteers)
◦ Most children with SAM without medical complications (80%)
can be treated as outpatients at accessible, decentralised sites
with RUTF.
◦ Children with SAM and medical complications are treated as
inpatients in SC.
◦ Community outreach for community involvement and early
detection and referral of cases
 Also known as community-based therapeutic care (CTC), ambulatory
care, home-based care (HBC) for the management of SAM
 Overall Goal and Objectives of the Program
 Goal
◦ To reduce malnutrition related morbidity and mortality
within communities.
 Objectives
◦ To prevent deterioration in nutritional status of the
population (treat moderate acute malnutrition).
◦ To prevent mortalities (treat severe acute malnutrition)
◦ To prevent and treat silent hunger of micronutrient
deficiencies.
◦ To promote proper breastfeeding and care practices
(IYCF)
◦ To promote personal hygiene and healthy practices.
◦ To integrate management of acute malnutrition into the
existing health facilities through capacity building of the
health workers.
Core Components of IMAM – 4 Components

Communi
Services and ty
programs Outreach
Out patient
addressing MAM
care for SAM
Services and/or programs
(Children and without to prevent undernutrition
PLW) complications
80% of SAM

Inpatient care
for SAM with
complications
20%
Core Components of IMAM - Community Outreach

1. Community Outreach:
 Community assessment
 Community mobilisation and sensitization
 Community outreach workers:
- Early identification and referral of children with
SAM before the onset of serious complications
- Follow-up home visits for problem cases
 Community outreach to increase access and
coverage
Core Components of IMAM - OTP
◦ Visit once per week
◦ Medical check (IMCI)
◦ Systematic Medications
◦ Treat infections
◦ Receive RUTF
◦ Health / Nutrition
Education
◦ Follow up of absentees
◦ Referral to SC
 Core Components of IMAM – SC & SFP
3. Inpatient care for children with SAM with medical
complications or no appetite (Stabilization Care –
SC)
 Child is treated in a hospital for stabilisation of the medical
complication
 Child resumes outpatient care when complications are
resolved
4. Services or programmes for the management of
moderate acute malnutrition (MAM)
 Supplementary Feeding Program (SFP)
4 Principles of IMAM
1. Maximum access and coverage
2. Timeliness
3. Appropriate medical and nutrition care
4. Care for as long as needed
Following these steps ensure
maximum public health impact!
Maximum Coverage and Access

Hospital with
inpatient care
Outpatient care
site
Inpatient care
site
Bringing Treatment Into the Local Health Facility and the Home
Timeliness: Early Versus Late Presentation
Timeliness (continued)
 Find children before SAM
becomes serious and medical
complications arise
 Good community outreach is
essential
 Screening and referral by
outreach workers (e.g.,
community health workers
[CHWs], volunteers)
Appropriate Medical Treatment and Nutrition Rehabilitation Based on Need
 Care For as Long as Needed
Care for the management of SAM is
provided as long as needed
Services to address SAM can be integrated
into routine health services of health
facilities, if supplies are present
Additional support to health facilities can be
added during certain seasonal peaks or during
a crisis
THANKS