Hi Mohammed,

The classification of a child as a 'non-responder' depends on the particular guideline you are using; i.e. there is no hard and fast 'rule' that says a child that does not respond in 12 weeks should be discharged. Guidelines around the world vary widely. As a personal opinion, the length of treatment before discharge for non-response is decided should be longer than 12 weeks. Children admitted with a low MUAC (e.g. less than 10) can take 12-15 weeks to recover even if they attend every OTP session. Episodes of illness or absenteeism can extend that period. 

Typically,  NGO emergency programmes would discharge as non-responder after 16 weeks. Action protocols would usually say that if a child has not been discharged cured after 12 weeks then they should be transferred to an inpatient unit for further investigation. In any guideline there should be some provision for the child to be transferred to inpatient for further investigation before being discharged as a 'non-responder'. 

I am not familiar with your latest edition of national guidelines but what to do next should be guided by the reason the child has become a non-responder. For example, has the child been absent frequently? has the child had a good appetite at each visit? has the child actually been receiving the full RUTF ration? has the child been experiencing repeated or prolonged episodes of illness during treatment?

I would suggest that if the reason is potentially a social one (e.g. absenteeism, sharing / selling  the ration of RUTF), there should be a community based follow up to try to fix the problem and treatment continued. If it is more likely a medical problem, transfer the child to inpatient care for futher diagnosis and treatment.

Many national guidelines normally suggest that if a child is still malnourished they should not be discharged at all. If a child remains in the programme, continue treatment using the same registration details and use another OTP card follow up section (usually on the back of the card). If the child is discharged (which I wouldnt recommend) then yes, the child can be 'readmitted', however this is not a new case of SAM (since you say they are still malnourished) so effectively you would then be reporting one child with one episode of malnutrition as 2 cases in reporting forms. If you do decide to discahrge and readmit, keep the same SAM number and readmit as an old case rather than a new case. 

In a national programme integrated into the health system, the child should not really be discharged as non-responder but transferred to another service (e.g. health, WaSH, IYCF / nutrition counselling etc.) for ongoing support. 

I hope this helps,

Paul

Hi Paul,

thanks so much for such an educating response, it really helps.

best regard

Mohammed