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Referral and warning signs
When to refer
Refer IMMEDIATELY to Inpatient Care if develops complications, fails appetite test, increasing oedema, or fails to gain weight.
Red flags
- Any General Danger Sign
- New/worsening oedema
- Failed appetite test
- Weight loss or static weight (2-3wks)
- Medical complications
Signs and symptoms
- Meets SAM criteria (MUAC<115mm OR WFH/L<-3z OR Oedema).
- AND Appetite Test PASSED.
- AND NO medical complications.
Risk factors
- See NUT004.
Diagnosis
Clinical assessment
- Classification based on anthropometry, oedema, appetite test, absence of medical complications (See NUT005).
Investigations
- Anthropometry.
- Oedema check.
- Appetite Test.
- Clinical assessment for complications.
Diagnostic criteria
SAM criteria met AND Passed Appetite Test AND No Medical Complications.
Management
Non-pharmacological management
- Enrollment in Outpatient Therapeutic Care (OTC).
- Counseling caregiver (RUTF administration, frequency, water, continued breastfeeding, hygiene, danger signs, follow-up).
- Provide take-home RUTF supply (weekly).
Pharmacological treatment
- Routine Medications at Admission: Amoxicillin DT PO BID x 5d. Deworming (Mebendazole/Albendazole if >=1yr). Measles Vaccine (if >=6m & not up-to-date). Vitamin A/Iron/Folate usually NOT needed (in RUTF).
- Treat co-existing conditions.
Monitoring
- Weekly Follow-up Visits Initially.
- Assess clinical condition (complications).
- Measure Weight, MUAC.
- Check Oedema.
- Perform Appetite Test (if concerns).
- Assess RUTF intake/tolerance.
- Provide next RUTF supply.
- Reinforce counseling.
- Monitor weight gain (>5g/kg/d).
- Check oedema resolution.
- Assess MUAC/WFH trend.
Complications
- Development of medical complications.
- Poor response / Failure to gain weight.
- Defaulting.
- Sharing of RUTF.
Prevention
- See NUT004.
Patient education
- Explanation of SAM/OTC program.
- RUTF as complete food.
- Correct RUTF administration.
- Importance ONLY RUTF (+breastmilk).
- Clean water need.
- Routine medications.
- Danger signs.
- Importance of ALL follow-up visits.
- Not sharing RUTF.
Uganda-specific notes
CMAM/OTC using RUTF standard for uncomplicated SAM >=6m. Relies on RUTF supply chain & trained HW/VHTs. Community screening/linkage key.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 19, Section 19.2.2.2
- Integrated Management of Acute Malnutrition Guidelines, MOH Uganda
(Detailed OTC protocols)