Chapter 7.6.1 Transfer to outpatient care
Children admitted to hospital with complicated severe acute malnutrition can be transferred to outpatient care during the rehabilitation phase. Social factors, such as loss of earnings for the mother and care for other children, should also be taken into account, as should the fact that those without complications can be managed as outpatients or in the community. Carefully assess the child and the available community support. The child will require continuing care as an outpatient to complete rehabilitation and prevent relapse.
The decision to transfer children to outpatient care should not be based on achievement of specific anthropometric or weight-for-height/length outcomes. Children should be discharged from hospital to outpatient or a nutritional programme when:
- they have completed parenteral antibiotic treatment, and are clinically well and alert
- medical complications are resolved
- their appetite has fully recovered and they are eating well
- oedema has reduced or resolved.
It is important to prepare the parents for outpatient treatment or in a community nutrition programme where such services are available. Ask the caregiver to bring the child back for weekly therapeutic food, and make sure the child receives vaccinations and routine vitamin A supplements, as appropriate.
The mother or carer should:
- be available for child care
- have received specific counselling on appropriate child feeding practices (types, amount, frequency)
- have the resources to feed the child. If this is not the case, give advice on available support.