OTP - 1.pptx

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1. Out-Patient Therapeutic Programme (OTP)

2. To understand the protocols of OTP Objective of the session

3. Classification for the Community Treatment of Acute Malnutrition * Complications anorexia or no appetite, intractable vomiting, convulsions, lethargy or not alert, unconsciousness, lower respiratory tract infection (LRTI), high fever, severe dehydration, severe anaemia , hypoglycaemia , or hypothermia **Children with MAM with medical complications are admitted to supplementary feeding but are referred for treatment of the medical complication as appropriate

4. The Outpatient Therapeutic Programme (OTP) is treatment at home for children with severe acute malnutrition with appetite and without medical complications. The majority (about 85%) of SAM children can be treated at home without the need for referral to inpatient care. Visit every week or two week Out-patient Therapeutic Programme (OTP)

5. Category Criteria (any of the following) Children 6-59 months MUAC < 11.5 cm (115mm) OR Bilateral pitting oedema grade + or ++ AND Appetite, clinically well and alert Mother/caretaker refuses inpatient care despite advice Other reasons for enrolment in OTP asons for OTP enrolment Transfer from inpatient care Child returns to OTP after transfer to in-patient care Or other OTP site after treatment or is referred to OTP after inpatient care or from another OTP site Return after default Children who return after default continue their treatment if they still fulfill the enrolment criteria for OTP Enrolment Criteria

6. Category Criteria     Cured MUAC >115mm Clinically well And 15% weight gain And No oedema for two consecutive visits (if admitted with oedema) Defaulted Absent for 3 consecutive visits (OTP is every week) Absent for 2 consecutive visits (OTP is every two weeks) Died Died during time registered in OTP   Not recovered* Has not reached exit criteria within 4 months.   Exit Criteria

7. Registration / Follow-up record Anthropometrics Physical examination Sugar Water Appetite Test Routine Medicines RUTF Ration Supplemental medicines if required Health Education Procedures

8. Identify and treat urgent cases first Offer water on arrival to all cases. Sugar water (10% sugar) should be given if sugar is available. (Two teaspoons of sugar / 100ml of water or 20 teaspoons in 1 litre of water) Step 1 - Triage

9. Anthropometric assessment MUAC Weight Oedema Step 2 - Anthropometry

10. Medical and dietary history Physical examination Use the Action Protocol (Page 78 of CMAM guidelines) to determine if there are any medical complications If the child has one or more medical complications transfer the child to inpatient care If the child has no medical complications give an appetite test Step 3 – Medical Assessment

11. Appetite must be assessed to see if the child will eat the RUTF necessary for recovery Step 4 – Appetite Test Appetite Observation Action Good Child takes the RUTF eagerly Child may continue in OTP Poor Child takes RUTF with persistent encouragement Child may continue in OTP but must be observed carefully for any weight loss or clinical deterioration Refused Child refuses RUTF even after persistent encouragement Transfer to inpatient care

12. Decide if the child should continue in OTP or be transferred to inpatient care If the child refuses to eat RUTF or has any medical complications he/she should be referred to inpatient Infants less than 6 months who meet the criteria (visibly wasted, have oedema or are too feeble to suckle effectively) Step 5 – Decide ?

13. Register RUTF according to weight Medicines Immunization Continue breastfeeding RUTF key messages Date and time of next visit Step 6 – Enrolment in OTP

14. Routine Medical Protocol for OTP 14

15. RUTF is food and medicine for malnourished children only. It should not be shared Sick children often don’t want to eat. Give small regular meals of RUTF and encourage the child to eat often (6 times a day is possible) Your child should have X (note the amount according to weight of child) amount of RUTF a day RUTF is the only food your child needs to recover during the time in OTP Breastfeed before giving RUTF. Young children should continue to breast feed regularly Key messages for OTP

16. Always offer plenty of breast milk or clean water to drink while eating RUTF. RUTF makes children thirsty and your child will need to drink more than normal. Use soap to wash your child’s hands before eating if possible. Keep food clean and covered When a child has diarrhea, never stop feeding. Give extra food and extra clean water. Children with oedema only : Don’t worry if your child looks thinner at first. This is because he/she is losing fluid from the body. Continue to give RUTF. Key messages for OTP …

17. Hand-washing with soap before eating and after defecation Exclusive breastfeeding (for 6 months) and introduction and use of appropriate complementary foods using locally available food Continued feeding during illness Three key messages

18. Explain to the caretaker Note the final outcome on the OTP card Advise the caretaker High fever Frequent watery stools with blood or diarrhoea lasting more than 4 days Difficult or fast breathing Vomiting Development of oedema   Counsel the mother/caretaker on good nutrition and continued breastfeeding for children less than 2 years How to use any medications that have been given / prescribed Refer to a Supplementary Feeding Programme (SFP) if available. Exit Notes

19. THANKS