THERAPEUTIC NUTRITION ACTIVITIES
1. TITLE AND DEFINITION OF THE ACTIVITY
THERAPEUTIC FEEDING PROGRAM
1.1. DEFINITION
Activity aimed at treating severe acute malnutrition (SAM) through in-patient and
community-based program.
1.2. INTERVENTION CRITERIA
 Global acute malnutrition (GAM) rate ≥ 10 %
 Global acute malnutrition rate < 10 % plus presence of aggravating factors
2. METHODOLOGY
2.1. Sector: Health and Nutrition
2.2. Sub-sector: Treatment of Severe Acute Malnutrition
2.3. Beneficiaries
 Direct:
 Indirect:
Children with severe acute malnutrition
Population of the coverage zone
2.4. Estimated length: depending on the needs evolution.
2.5. Counterparts: Ministry of Health, local NGOs, community committees.
2.6. Specific goals:
 To treat adequately cases of severe acute malnutrition
2.7. Activities:
2.7.1. To open therapeutic nutrition centres/units. Two kinds: in hospitals, and inside the
community.
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 In-patient care: Therapeutic Feeding Centre/Unit
Patients that require in-patient care have a poor appetite and usually have a
complication such as diarrhoea, dehydration, sepsis, pneumonia, severe anaemia, etc.
These children will account for 20 – 30 % of the SAM cases.
Treatment phases:
Phase 1 / Acute phase: Patients with an inadequate appetite and/or an acute major medical
complication are initially admitted to an in-patient facility for acute-phase treatment. The
formula used during this phase (F75) promotes repair of physiological and metabolic functions
and electrolyte balance. Rapid weight gain at this stage is dangerous, that is why F75 is
formulated so that patients do not gain weight.
Transition phase: A transition phase is then introduced because sudden change to large amounts
of diet, before physiological function is fully restored, can be dangerous and lead to electrolyte
disequilibrium and “recovery syndrome”. During this phase the patients start to gain weight.
RUTF (or F100) is introduced. The quantity of RUTF 1 given increases the energy intake by about
30%. The increase in energy intake should give a weight gain of around 6g/kg/d.
Transfer to Out-patient Treatment Program (OTP): Whenever patients have a good appetite and
no acute major medical complication, they are given RUTF and transferred to OTP. These
formulae are designed for patients to rapidly gain weight (more than 8 g/ kg/ day).
 Out-patient treatment program (OTP) or Phase 2:
Children who have no medical complications, no open skin lesion, no bilateral pitting oedema
grade 3, and pass the appetite test should be admitted directly into Phase 2 and treated at
home.
o
o
o
These children will attend the OTP once a week (the OTP sites should be close to or
within the community).
An anthropometric and medical check-up will be conducted, and they will receive the
ready-to-eat food (RUTF) and systematic treatment they need.
These children will account for 70-80% of the SAM cases.
Discharge:
o The mean length of stay in the OTP should be around a month, depending on the child
evolution.
Notice that children that have been previously admitted in the in-patient facility will need
more time to fully recover.
2.7.2. Staff training to implement a therapeutic feeding programme.
1
Ready to Use Therapeutic Food: A kind of food that is ready to eat without the need to cook or dilute it.
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2.8. Indicators:
 Number of severely malnourished children admitted to the TFP.
 Number of Therapeutic Nutrition facilities operating (in hospitals and in the
community).
 Analysis of the origin and status of the beneficiaries in the nutritional centres.
 Cured rate ≥ 80%
 Dead rate < 5%
 Defaulter rate < 15%
 Gain of weight ≥ 8g/kg/day
 Length of stay < 42 days
2.9. Expected results:
 The mortality and the morbidity related to acute malnutrition have dropped in the
intervention zone.
2.10. Sources of verification:
 ACF reports and statistics
 Reports from counterparts
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3. RESOURCES
3.1. HUMAN
3.1.1. “Therapeutic Feeding Centre” team:
Purpose
Program Manager
Program manager assistant
Programme staff
Supervisor
Doctor
Nurse
Registrar
Health educator
Phase monitor
Cook
Cleaner
Psychosocial worker
Support staff
Storekeeper
Guard
Status
No. of
staff
members
Length
Comments
1 expat for the whole
TFP, but could have 1
more expat for the
opening phase
Expat
1
End of project
National
1
End of project
National
National
National
National
National
National
National
National
National
1
1
4
1
1
6
3
3
1
End
End
End
End
End
End
End
End
End
National
National
1
4
End of project
End of project
Per 100 beneficiaries
of
of
of
of
of
of
of
of
of
project
project
project
project
project
project
project
project
project
The staff needs are just a first idea. Staff needs depend on the number of beneficiaries, the level
of education/experience/understanding of the staff, and the number of expats in charge.
3.1.2. “Out-patient Treatment Program” team
Purpose
Status
No. of
staff
members
Length
Comments
Program Manager
Expat
0 or 1
1 or 2 months
1 for the opening
phase, depending on
the workload
Programme staff
Supervisor
National
1
End of project
Medical worker
National
1
End of project
Registrar
National
1
End of project
Medical assistant,
nurse or doctor
If low workload, the
measurers can do the
registration
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Measurer
Health educator
National
National
2
1
End of project
End of project
Food distributor
National
1
End of project
Home visitor
National
2
End of project
Not needed if the
workload is low
If no community
volunteers; number
depending on the
caseload and the area
to cover.
3.1.2. Community participation:
3.2. MATERIAL
To be completed when the revision of the emergency kits will be finalised.
3.3. FINANCIAL
In order
mind:






to draw up the budget related to this activity, the following should be kept in
Programme and support staff.
Programme materials (equipment, supplies, food).
Possible rental of facilities and/or warehouses and/or vehicles.
Visibility of donors.
Training.
And other expenses to support implementation of the activity.
Keep in mind the format and rules of each donor.
4. BIBLIOGRAPHY
o
ACF Guidelines for the Integrated Management of Severe Acute Malnutrition: In and OutPatient treatment.
o
MANAGEMENT OF SEVERE MALNUTRITION: A MANUAL FOR PHYSICIANS AND OTHER SENIOR
HEALTH WORKERS. WHO, Geneva, 1999
http://whqlibdoc.who.int/hq/1999/a57361.pdf
o
ENN (Emergency Nutrition Network) Special Supplement Series, No. 2, November 2004
Community-based Therapeutic Care (CTC)
http://www.ennonline.net/fex/23/supplement23.pdf
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o
Yvonne Grellety, 2004. The Care of Acute, Moderate Malnutrition Prevention of severe
wasting: Targeted Supplementary Feeding Programme
o
Logistic file on Emergency Response System Kits
o
Humanitarian Standards Pocket Guide. The Sphere Project, June 2006
http://www.sphereproject.org/component/option,com_docman/task,doc_view/gid,122/I
temid,203/lang,english/
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