MUAC changes In a similar way as body weight.  So these children with slowing changing MUAC are also not gaining weight.  Such children likely need evaluation for co-morbid conditions, such as chronic infections (HIV and TB).

Weight gain is often influenced by underlying diseases such as HIV, TB, measles, etc.

A child whose length of stay exceeds what is considered normal in the program must necessarily be evacuated to a reference center for in-depth analysis.

It's true that weight gain can be influenced by various factors, including underlying diseases like HIV, TB, and measles. However, it's important to be cautious about making generalizations and understand that each case is unique and requires individualized assessment.

While weight gain can be a symptom of some illnesses, it can also be related to other factors like nutrition, genetics, and developmental stage. For instance, a child experiencing rapid weight gain without other concerning symptoms might simply be undergoing a healthy growth spurt.

Similarly, while a child exceeding the normal length of stay in a program could be concerning, evacuation to a reference center shouldn't be an automatic response. Several factors need to be considered before such a decision is made, including:

• Specific reasons for the extended stay: Is it due to health concerns, lack of progress in the program, or social/emotional factors?
• Severity of any suspected health issues: What are the child's specific symptoms, and have they undergone any preliminary assessments?
• Availability and capabilities of the reference center: Can they provide specialized care that's unavailable in the current program?
• Potential risks and benefits of evacuation: Would the transportation and change in environment be more harmful than staying in the current program?

Instead of a direct evacuation, a more nuanced approach is often preferable. This may involve:

• Thorough assessment by a qualified healthcare professional: This could involve physical examinations, diagnostic tests, and consultations with specialists to identify any underlying medical causes for the weight gain or extended stay.
• Addressing any identified health issues: Treatment plans should be tailored to the specific condition diagnosed.
• Exploring alternative solutions within the program: Perhaps the program can adapt its approach to better meet the child's needs and facilitate progress.
• Continuous monitoring and communication: Regularly monitoring the child's progress and communicating openly with caregivers and healthcare professionals is crucial to inform further decisions.

Remember, evacuation to a reference center should be a carefully considered last resort, only undertaken when it's demonstrably the best course of action for the child's well-being.

Kemal J Tunne

Emergency Nutrition Coordinator.

Several factors explain this situation in the context of care:

- the quality of medical care, namely the systematic treatment which must be correctly carried out at the start of admission and the specific treatment following the associated pathologies. Some medical situations even require the patient to be interned and treated

- nutritional treatment which must be well adapted to the patient and correctly taken. For this, home visits may prove necessary to not only ensure the correct and complete intake of nutritional rations, the psychosocial atmosphere conducive to the patient's development.

- compliance with medical and nutritional treatment is very essential in care and attention must be paid to it

NB: it is also noted according to certain studies that at the start of SAM treatment, there is a significant increase in weight and MUAC, then gradually this increase becomes less significant. Nutritional needs have been sufficiently covered and are tending to stabilize, hence the slow increase in parameters.