Ideally, OTP and TSFP should have integrated service centres so that a child who is discharged from OTP is also admitted to TSFP on the same day. This will prevent leakage in the continuum of care and result to a seemless transition. In this case, the length of stay in OTP should be calculated as the duration between admission date and discharge date.

You asked: What do you do when the child attains a MUAC of 11.5cm on a two-consecutive visit in a region where there is no TSFP programme implementation?

Response: In the absence of the a national guideline, consider treating the child with RUTF until discharge at 12.5cm ( discharge when 2 consecutive viists with MUAC >12.5cm). See WHO 2013 Guideline: updates on the management of severe acute malnutrition in infants and children.

The average length of stay for children in the OTP program is calculated based on the time they spend in the program from admission to discharge. This excludes the time the child spent at home before reporting to the program. The reason for this is that the program is designed to provide treatment and support to children who are severely malnourished and require close monitoring and care. Once a child has reached a stable condition and is able to maintain nutritional status at home, they are discharged from the program.

The fact that the child is taken home with a supply of therapeutic food is intended to help them maintain their nutritional status while they are no longer receiving daily monitoring and care from the program. However, it is important to note that home-based care is not as effective as program-based care for children with severe malnutrition. This is because it is more difficult to ensure that children are receiving the correct amount of food and are adhering to the treatment plan when they are not under direct supervision from trained healthcare professionals.

Addressing the second question:

If a child attains a MUAC of 11.5cm on two consecutive visits in a region where there is no TSFP program implementation, the following steps should be taken:

1. Counsel the caregiver on the importance of continued care and provide them with education on how to maintain the child's nutritional status at home. This includes information on how to prepare and feed the child nutritious foods, as well as how to monitor their growth and development.

2. Provide the caregiver with a supply of therapeutic food to take home. This will help to ensure that the child has access to the necessary nutrients to continue their recovery.

3. Refer the child to the nearest TSFP program if there is one within reasonable distance. This will allow the child to continue receiving regular monitoring and care from trained healthcare professionals.

4. If there is no TSFP program within reasonable distance, follow up with the child and caregiver at regular intervals to monitor their progress. This will help to identify any early signs of deterioration and ensure that the child is receiving the necessary support.