Therapeutic Feeding Programs.

Therapeutic Feeding ProgramsType of program: Therapeutic feeding program (TFP)

Objectives: To provide medical and nutritional treatment for the severely malnourished.To reduce and prevent excess mortality.

Target group: Severely malnourished children 6-59 months of age, with <-3 Z scores (<70% reference median) WFH and/or edemaOther severely malnourished individuals based on WFH, MUAC, BMI and/or edema, illness or lack of appetite

When to start: When existing health/nutritional services are inadequate to handle the number of severely malnourished individuals, and when resources are available

Therapeutic Feeding Programs: Entry and Discharge Criteria

Entry:<-3 Z scores (<70% reference median) WFH and/or edemaOther anthropometric or clinical signs or lack of appetite

Discharge:Discharge: >=-2.5 Z scores or >=75% reference median WFH for 2 successive weeksGood appetiteFree of illnessDealt with causes at household level to prevent relapse

Therapeutic Feeding ProgramsSevere PEM is a medical emergency! Major causes of death: starvation, hypoglycemia, hypothermia.In cases of kwashiorkor: other medical complications including congestive cardiac failure Phase 1: Intensive Care Phase (24 hr care – 1 week)

Objectives: control infection, rehydrate, treat malaria, intestinal parasites, septic shock, dermatitis of kwashiorkor, measles immunization and Vit AFeeding: 10-12 feeds/day with therapeutic milk (F75, F100)

• Aiming for 80-100 kcals/kg body weight/day, micronutrients

• Continued breastfeeding for infants whenever possible

Phase 2: Rehabilitation Phase (daily care – 5 weeks)Objectives: Weight gain, train caretakerFeeding: 6 meals/day with mixture of therapeutic milk and cereal-based porridge based on fortified blended foods, transition to a local diet. Feed as much as the child will eat – aiming for at least 150 kcals/kg body weight/day

Therapeutic Feeding Programs: Program Monitoring

Acceptable

Alarming

Recovery rate - % enrollees who are no longer registered because of recovery

>70% <50%

Death rate - % enrollees who are no longer registered because of death

<10% >15%

Default rate - % enrollees who stop attending program for 48 hours

<15% >25%

Weight gain (g/kg/day) >=8 <=8

Coverage >50-70% <40%

Mean length of stay <3-4 weeks

>6 weeks

Therapeutic Feeding Programs:Phasing Out

TFP should be phased out as soon as existing health facilities are adequate to care for severely malnourished individuals with appropriate services, follow-up and sensitization are implemented in cases of malnutrition, and no large-scale nutritional deterioration is expected.

Key references

WHO. The Management of Nutrition in Major Emergencies (2000).Mason, J. Lessons on the Nutrition of Displaced People. J Nutr. 132: 2096S-2103S, 2002ACC/SCN. Fourth Report on the World Nutrition Situation (2000).WHO. Field Guide on Rapid Nutritional Assessment in Emergencies (1995).ACC/SCN. Assessment of Nutritional Status in Emergency-Affected Populations: Adolescents (2000).ACC/SCN. Assessment of Nutritional Status in Emergency-Affected Populations: Adults (2000).Emergency Nutrition Network. Infant Feeding in Emergencies: Policy, Strategy and Practice (1999).WHO. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers (1999).MSF. Refugee Health (1997).ACC/SCN. Report on the Nutrition Situation of Refugees and Displaced Populations (2001).