Is there a standard definition of "clinically well" as an exit criteria from outpatient progrmame to treat acute malnutrition? I recently encoutered some confusion about the meaning of this term among health workers and agency nutrition staff with agencies discharging children at different points due to different interpreations of the guidelines. One site that I visited was keeping children in programme (sometimes for several weeks) after they met the MUAC discharge criteria due to caregiver reports of cough, fever or diarrhoea.
The latest national guidelines for this country do not have a definition of clinically well and I couldn't see this in the guidelines of a few other countries that I quickly checked so I wondered if this existed anywhere.
Hi Anonymous,
I'm not aware of any standard definition, but being 'clinically well' would imply an absence of disease. That said, it is not unreasonable to interpret this on a case-by-case basis ensuring that a proper patient assessment is done.
The history reported by the carer should not be the only foundation for decision making; the child should also have a clinical examination to identify any correlating signs and symptoms. The child's progress should also be taken into account; for example, if the carer reports diarrhoea, yet the child's weight / MUAC is increasing and the child appears well with good appetite on examination I would probably discharge the child from the OTP. Ask the carer to bring the child back to the health centre next week if symptoms continue or the child becomes unwell. This should be coupled with counselling on WaSH and nutrition practices and referral for any relevant vaccinations etc.
I dont think the issue is the definition of 'clinically well' so much as the process of assessment to arrive at the decision to discharge or not. At the site you mention with prolonged LOS, the staff likely just need some guidance from supervisiors.
I hope this helps,
Paul
Answered:
4 years ago