They are all independent admission criteria......I would wonder if the MUAC or WHF Z-score measurement are so correct........but I will suggest you retake the MUAC and or Both measurements. 

This is clear  MUAC< 11.5  Admissions criteria for OTP

Dear Abdelrahim,

Since the child MUAC measurement is <11.5cm, the case is definitly SAM and is OTP criteria. 

The admission criteria being independent, it is recommended to consider the MUAC in this specific case to classify the child as a SAM.

As for the management of the child, it will be necessary to find out if his appetite is preserved or if he has medical complications:

- If his appetite is good and he is alert, then he can be treated on an outpatient basis in a health facility (OTP).

- If he does not have a good appetite or has medical complications, he will be treated as an inpatient in a stabilisation centre or facility.

In Somalia  majority of malnourished  children are  detected  through weight  for  height,  if the child shows malnutrition in MUAC they are more  critical than when it shows malnutrition in z score, therefore in your case  children showing MUAC less 11.5CM are suffering severe acute malnutrition and OTP programme is the deal support to save their lives .

Dear friend),

Mr. KIAWARA Léonce explained so well that I recommend to you what he gave as an explanation.

Dear Abdirahim

Most guides said you can choose either criteria MUAC or WHZ. However, a lot of studies showed MUAC (<11.5 cm) as better indicator of mortality than WHZ (<-3). That means by using MUAC for admission you can assure to save more lives.

However, the choice should also depend on your case load. If your OTP caseload is still manageable, you may choose the criteria that make more admission. If not, you may choose the another.

It is also important to note that discharge criteria should be the same as the admission criteria.

Dear team,

In the standard indicators of SAM case identification the range from Oedema, MUAC and Z-Score, when doing admission you prioritize the first admission criteria which is oedema, in the absence of oedema, the next criteria is MUAC then followed by Z-Score at least the measurement was not done appropriately. 

In this case I will advise you to prioritize MUAC after a confirmation from another technical nutritionist to confirm both the first MUAC and the weight were taken correctly. 

Thanks, 

Dear Abdirahim,

It is also important that you consult the national protocol or guidelines for programme admission, discharge and management for the country in which you are working. 

Best wishes,

Tamsin

Excelente pregunta, ya que comparto la preocupación, tiempo atrás pregunté algo similar en este chat. En Colombia, a pesar que el Lineamiento actulizado 2020 reconoce los tres criterios como independientes, se sigue presentando gran discusión entre los equipos tratantes; incluso el Instituto Colombiano de Bienestar Familiar - icbf, no acepta en sus modalidades de atención a niños detectados por MUAC< 11.5 cm. Seguiremos atentos. Gracias por la pregunta y por las demás respuestas.

Excellent question, as I share the concern, some time ago I asked something similar in this chat. In Colombia, despite the fact that the updated 2020 Guidelines recognize the three criteria as independent, there is still much discussion among the treatment teams; even the Colombian Institute of Family Welfare - icbf, does not accept children detected by MUAC< 11.5 cm in their care modalities. We will remain attentive. Thank you for the question and for the other answers

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