Hi , In setting up CMAM services we have the SC model which aims to stabilize children with SAM and medical complications then refer them to the OTP to finish their treatment before being sent to SFP. Setting SFP can be done independantly with support of TFC rather than SC I beleive where the child has to stay all the period in the TFC until reaching 80% WFH then sent to the SFP, however the child in the SC even after resolving medical complications still have SAM and not fit for receiving treatment for moderate acute malnutrition and in such case if we choose to treat the child in the TFC we should be prepared for possible increased deafulter rate , these is reflecting what i have seen in the field , but am also interested if any experience or study of treating SAM WITH NO MEDICAL COMPLICATION with FBF. Kind Regards

I do agree with the fact that TFCs may leave large number of defaulters, but with a network of SFPs in the community and a proper referral system, it would be easier to follow-up these cases in the community as well. The question is that if we do not have enough resources for RUTF, should we leave the moderate cases (at risk of developing severe malnutrition) as well?

Hi Dr Najeeb, Is this a programme to catch children that become malnourished during a relatively food secure time, or is it part of an emergency response with high or rising levels of acute malnutrition? In a non emergency response there are often SFP's running where referral of SAM children is to a TFC because the numbers needing referral are very low. More recently, in non emergency contexts, there are programmes where there is no SFP but there are OTPs acting as a safety net (using RUTF) with referral to an SC or TFC for treatment of complications. As Tariq said, referring to an SC where there is no OTP is not a good solution. The severes need their SAM treated before moving on to blended foods. I dont know of any research papers that look at this specifically but what we know from practice is that where SAM children have been treated in an SFP some certainly do regain weight. However just using blended foods the recovery will most likely be slower and they will not get the optimum diet with all micro and macro nutrients required to fully treat SAM. An SC cannot adequately support an SFP. But definately it would be better to go ahead with the SFP with the aim of treating the much higher number of children that will be moderately malnourished and preventing deterioration to severe. Maybe you can find additional funds for treating SAM later, or you can find a way to support the nearest paediatric ward to act as a TFC for referrals from the SFP in the interim.