Dear colleagues, As a complement to our presentation at the ENN technical meeting in Oxford this week, we would appreciate your feedback on the draft inter-agency [url=http://www.ennonline.net/cmamexpandedadmissionsguidance]guidance note[/url] on using expanded admissions criteria during emergencies. Specifically, we are seeking feedback on the following questions: What criteria would you propose to clarify when or when not to use expanded admissions criteria to integrate SAM/MAM treatment during an emergency? Can you share your experiences when either RUTF or RUSF was not available, and the solutions you explored to ensure treatment programs were not disrupted? Thanks, Jeanette

Thank you for sharing the guidance note and I have some questions 1. why do MSF use weight-for-height ratio <80% but MUAC<110mm 2. what is the initial ground to use dosage Dosage: <115mm- 2 RUTF/day, between 115mm - <125mm- 1 RUTF or RUSF/day 3. what is the criteria to from expanded if the one or two of the unavailable components already started.TO make clear if a SAM child was on RUSF and the OTP program now available how to switch to RUTF, why not end with RUSF

Thank you for your response. I am currently replacing Jeanette. I will try to answer your questions in the same structure: 1. The study in Niger was conducted in 2006, when weight-for-height was still used. The admission criteria were meant to cover severe and moderate acute malnutrition simultaneously and only distinct between with and without complications. Although MUAC cut-offs even then were <125 mm for MAM, the MSF team on the ground decided to use 110 mm instead. I would need to contact the team responsible for the study. The study is included as it does provide OTP treatment with expanded criteria, but as you can see later on, this guidance note does request to use more updated admission criteria based on MUAC. 2. The difference is made between severe and moderate acute malnutrition where in SAM, the treatment is meant to cover all nutritional needs and thus amount of RUTF or RUSF is higher. For MAM cases, the treatment is meant to be supplemental and thus lower amount is provided. This is in line with international recommendation although this guideline is also a temporally solution in case of emergency, and thus normal national and international protocols/guidelines should be followed the moment all products are available. 3. This is maybe not clearly defined in the guidance note, but it does mention that the moment the needed treatment programs with nutrition products are available, transition to treatment based on local national and international protocols/guidelines should be done. How this transition should be organized depends on the situation at hand, and thus might need to be identified on an individual basis till this is defined. Does this respond your questions? Are you considering implementing the guideline? If you do, it would be interesting if you could share your results as this guideline is still very much under development and field experience might strengthen it. Regards, Stien

Thank You Stien! Shishay