Hi Mohammed,

The use of sex-combined weight-for-height tables is quite common and shouldn't be problematic in most cases. In the CMAM context the TFC and OTP should operate according to common admission and discharge criteria. This can occasionally be an issue when different organisations implement different components of the programme in emergency contexts - but these issues should be resolved at coordination meetings (e.g. through the nutrition cluster or similar). If there are national guidelines then those can be used to standardise the criteria between agencies. 

In OTP a child may be recovering (and now doesn't fit the admission criteria) but is not responding to treatment and acheiving cure. These non-responders should be referred to the TFC, as you suggest, and in the CMAM context the TFC should have admission criteria that include children that are not responding to treatment in OTP. 

So it seems that some coordination between the TFC and OTP implementers is required with agreement on admission, transfer and discharge criteria. 

Does this answer your question?

Paul.

Thanks Dr Paul

In Niger, we opted for the Z-Score and the MUAC to be independent criteria for admission to the various nutritional rehabilitation programs and this during the revision of the national protocol for integrated management of malnutrition (PCIMA) in 2016. However, some children do not respond to treatment. It is important to look for the cause of the non-response which may be linked to an underlying pathology, factors linked to the community (e.g. sharing of the ration with the other children of the household ...; factors linked to the health center (e.g. frequent breaks in availability of inputs, exceeding the capacity of the center, etc.).

Indeed if after examining those factors we decide to refer the child, it is necessary to ensure that he/she meets the admission criteria of the structure which should welcome him.