Comprehensive Nutrition Care and Support Facility-Level Job Aids

For Out Patient Therapeutic Care in Health Facilities Supported by NuLife

Your Role as a Facility-Level Health WorkerNutrition Care and Support for Children

Card 1

Assessing Appetite test/ Counselling/Reporting

Consulting Referral Card

Your Role as a Facility-Level Health Workerin Nutrition Care and Support Programs

Card 2

Assessing Appetite test/ Counselling/Reporting

Consulting Referral Card

Using a MUAC Tape for Nutritional Assessment

Card 3

MUAC stands for “mid upper arm circumference”. A MUAC tape is a simple tool to measure a person’s nutrition status.

There are 4 different tapes, for 4 age groups.

Each MUAC tape has the same color coding:

severe acute malnutrition (SAM) moderate acute malnutrition (MAM) mild or no malnutrition

0 cm

0 cm

Infants from 6 months and children up to 6 years

Adults older than 18 years, pregnant and postpartum women

Children 6 years up to 10 years

Children 10 years up to 18 years

Target Groups for MUAC Measurement

Card 4

Infants from 6 months & Children less than

18 years

Adolescents & Adults( 18 years and above)

Pregnant & PostpartumWomen with infants less than

6 months old

Steps to accurately use a MUAC tape

1. Bend left arm at angle of 90 degrees 2. Locate tip of shoulder 3. Locate tip of elbow

10. Read the cm measurement in the window at arrow11. Record measurement and the color zone observed

4. Place tape at 0 cm at tip of shoulder 5. Pull tape past tip of bent elbow and read length of upper arm

6. Determine mid-point by: - Folding the tape in half from “0” to the measured length OR - Calculating 7. Mark mid-point using finger or pen

1

1

2

4

6

3

5

8. Straighten arm and place MUAC tape around the mid-point9. Place MUAC tape through window of tape, and correct the tape tension

Tape too tightTape too Loose

Card 5

Card 7

How to Assess for Bilateral Pitting OedemaOedema is of nutritional significance only if it is bilateral and starts from the feet.

Apply firm pressure with your thumbs to both feet for three full seconds then remove your thumbs.

Grade 1 (+): If a depression persists on both feet, this indicates that the patient has bilateral pitting oedema. Grade 2 (++): If the feet are oedematous, repeat the process on the leg. Grade 3 (+++): If the leg is oedematous, repeat the process by pressing the thumb into the forehead.

Card 8

RUTF

• RUTFstandsforReady-to-useTherapeuticFood.

•RUTFisspeciallymadetotreatmalnutritionandcanonlybeprescribed by a health worker

• RUTFshouldnotbeshared

• Theclientshouldeatandcompletethedailyprescribedamount of RUTF sachets ( packets).

• Iftheclientdevelopsanysymptomssuchasdiarrhoea,vomiting,etc while on RUTF, he or she should see a health worker

How to give RUTF to a malnourished child

Card 9

Always offer plenty of clean water (or breast milk) while eating RUTF. RUTF makes your child thirsty and your child will have to drink more than usual.

Use soap and clean running water to wash your child’s hands before eating.

(if breastfed child) Breastfeed your child before giving RUTF. Young children should continue to breastfeed regularly.

RUTF is for the malnourished child only and should not be shared. Ensure that your child completes the daily dose of RUTF as instructed by the health worker.

How should a Malnourished Adult take RUTF

Card 10

Use soap and clean running water to wash your hands before eating.

Always drink plenty of clean water while eating RUTF. RUTF makes you thirsty and you will have to drink more than usual.Ensure that you complete the daily dose of RUTF as given by the health worker.

RUTF is for you only and should not be shared. Ensure that you complete the daily dose of RUTF as instructedd by the health worker.

How to Protect, Store and Safely Dispose of Empty RUTF Sachets

Card 11

The RUTF sachet should be put out of reach of people, rodents, insects and sun. You can keep RUTF in a covered basket hanging on the beams of the roof, a covered pot or bucket or in a closed cupboard.

The RUTF packet should be rolled after every use and remaining RUTF in the packet should be put in sealed plastic bag until next dosing.

Always dispose of the empty packets of RUTF safely, either by putting them in a latrine or by burning them.

Card 12

How to Take Weight of Children Up to 25 kgs

Hook the scale to a tripod or a stick held horizontally by two people at eye level. Suspend the weighing pants from the lower hook of the scale and readjust the scale to zero. Undress the child and place him or her in the weighing pants. Make sure one of the child’s arms passes in between the straps, to prevent him or her from falling. Hook the pants to the scale. When the child is settled and the weight reading is stable record the weight to the nearest 0.1kg. Ensure that the child hangs freely without holding onto anything. Read and announce the value from the scale. The assistant should repeat the value for verification and record it immediately.

How to Take Weight of Adults and Small Children

Card 13

The client is required to dress in light clothes and take off shoes. Women should remove their scarf. The client should stand straight and unassisted on the centre of the balance platform. The weight should be recorded to the nearest 0.1 kg.

When the weight of a baby is required: take the weight of the adult with and without baby. The ba-by’s weight is the difference between both weights.

Make sure the scale is at zero before taking a measurement.

If you are using an electronical scale do this by passing your hand over the window.

Card 12

Ag

e g

rou

pSA

MM

AM

+ H

IVM

ust

Ap

ply

To

All

Cas

es

6 m

onth

s to

< 6

yea

rs

MU

ACRE

D(<

115

mm

)

OR

Bila

tera

l Pitti

ng

oede

ma

+ or

++

MU

AC

YELL

OW

(>11

5 to

<12

5 m

m)

&

No

Oed

ema

Pass

ed a

ppeti

te te

st

No

open

ski

n le

sion

s

Clin

ical

ly w

ell o

r m

ild

in

fecti

onA

lert

C

areg

iver

will

ing

to

tr

eat f

rom

hom

eH

ome

envi

ronm

ent

co

nduc

ive

to c

onst

ant

feed

ing

as re

quire

d

6 to

< 1

0 ye

ars

MU

ACRE

D(<

135

mm

)

OR

Bila

tera

l pitti

ng

oede

ma

+ or

++

MU

AC

YELL

OW

(>13

5 to

< 1

45 m

m)

&

No

Oed

ema

10 to

< 1

8 ye

ars

MU

ACRE

D( <

160

mm

)

OR

Bila

tera

l pitti

ng

oede

ma

+ or

++

MU

AC

YELL

OW

(>16

0 to

< 1

85 m

m)

&

No

Oed

ema

18 y

ears

and

old

er(H

IV +

onl

y)

Preg

nant

wom

en a

nd

lact

ating

/non

-lact

ating

w

omen

with

infa

nts

unde

r 6

mon

ths

of a

ge(H

IV +

onl

y)

MU

AC

RED

(< 1

90 m

m)

OR

Bila

tera

l Pitti

ng

oede

ma

+ or

++

MU

AC

YELL

OW

( <

220

mm

)

&

No

Oed

ema

Pass

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ppeti

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No

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Clin

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Card 13

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Card 14

Weight at Admission & Target Weight for Discharge(1.2 X admission weight of a child/ adolescent or 1.1 X admission weight of adult)

Weight at Admission (Kg)

Target Weight

(Minimum Expected Weight at Discharge)

(Kg)3.0 – 3.4 3.6 – 4.03.5 – 3.9 4.2 – 4.74.0 – 4.4 4.8 – 5.34.5 – 4.9 5.4 – 5.95.0 – 5.4 6.0 – 6.55.5 – 5.9 6.6 – 7.16.0 – 6.4 7.2 – 7.76.5 – 6.9 7.8 – 8.37.0 – 7.4 8.4 – 8.97.5 – 7.9 9.0 – 9.58.0 – 8.4 9.6 – 10.08.5 – 8.9 10.2 – 10.79.0 – 9.4 10.8 – 11.39.5 – 9.9 11.4 – 11.9

10.0 – 10.4 12.0 – 12.510.5 – 10.9 12.6 – 13.111.0 – 11.4 13.2 – 13.711.5 – 11.9 13.8 – 14.312.0 – 12.4 14.4 – 14.912.5 – 12.9 15.0 – 15.513.0 – 13.4 15.6 – 16.113.5 – 13.9 16.2 – 16.714.0 – 14.4 16.8 – 17.314.5 – 14.9 17.4 – 17.915.0 – 15.4 18.0 – 18.515.5 – 15.9 18.6 – 19.1

Weight at Admission (Kg)

Target Weight

(Minimum Expected Weight at Discharge)

(Kg)16.0 – 16.4 19.2 – 19.716.5 – 16.9 19.8 – 20.317.0 – 17.4 20.4 – 20.917.5 – 17.9 21.0 – 21.518.0 – 18.4 21.6 – 22.118.5 – 18.9 22.2 – 22.719.0 – 19.4 22.8 – 23.319.5 – 19.9 23.4 – 23.920.0 – 20.4 24.0 – 24.520.5 – 20.9 24.6 – 25.121.0 – 21.4 25.2 – 25.721.5 – 21.9 25.8 – 26.322.0 – 22.4 26.4 – 26.922.5 – 22.9 27.0 – 27.523.0 – 23.4 27.6 – 28.123.5 – 23.9 28.2 – 28.724.0 – 24.4 28.8 – 29.324.5 – 29.9 29.4 – 35.930.0 – 30.4 33.0 – 33.430.5 – 30.9 33.6 – 34.031.0 – 34.9 34.1 – 38.435.0 – 39.9 38.5 – 43.940.0 – 44.9 44.0 – 49.445.0 – 49.9 49.5 – 55.050.0 - 54.9 55.0 – 60.455.0 – 59.9 60.5 – 65.9

Card 15

Task Frequency

1. Patient attends health facility Weekly/Biweekly

2. Replacement of RUTF Every Visit

3. Weight & MUAC Every Visit

4. Clinical Examination Every Visit

5. Appetite Test Every Visit

6. Update client card and ration card Every Visit

7. Counselling/Nutrition Education Every Visit

Follow Up Visits

Cri

teri

a fo

r D

isch

arg

e fr

om

Ou

tpat

ien

t Th

erap

euti

c C

are

(OTC

)

Oth

er C

rite

ria

Ag

e g

rou

pD

isch

arg

e C

rite

ria

(if

no

SFP

)M

UST

AP

PLY

TO

ALL

C

ASE

S

6 m

on

ths

to <

6 y

ears

Att

ain

s ta

rget

wei

gh

t(W

eig

ht

gai

n o

f ≥

20%

)&

MU

AC

>115 m

m (

SAM

)M

UA

C >

125 m

m (

MA

M)

No

oed

ema

for

2

co

nse

cuti

ve v

isit

s

& C

lin

ical

ly w

ell

6 t

o <

10 y

ears

Att

ain

s ta

rget

wei

gh

t(W

eig

ht

gai

n o

f ≥

20%

) &

MU

AC

>115 m

m (

SAM

)M

UA

C >

145 m

m (

MA

M)

10

to

< 1

8 y

ears

Att

ain

s ta

rget

wei

gh

t(W

eig

ht

gai

n o

f ≥

20%

)&

MU

AC

>160 m

m (

SAM

)M

UA

C >

185 m

m (

MA

M)

18

yea

rs a

nd

old

er

Pre

gn

ant

wo

men

&

Lact

atin

g/n

on

-lac

tati

ng

w

om

en w

ith

in

fan

ts

< 6

mo

nth

s o

ld

MU

AC

> 2

20 m

m (

SAM

)

MU

AC

> 1

90 m

m (

SAM

)

Wei

gh

t g

ain

of

≥ 1

0%

N

o o

edem

a fo

r 2

con

secu

tive

vis

its

& C

lin

ical

ly w

ell

Die

dD

ied

du

rin

g t

ime

reg

iste

red

in

OT

C

No

n-r

esp

on

den

tH

as n

ot

reac

hed

dis

char

ge

crit

eria

aft

er f

ou

r m

on

ths

(16 w

eeks)

(N

ote

: ac

tio

n s

ho

uld

be

taken

if

no

n-r

esp

on

den

t at

3 v

isit

s)

Def

ault

edA

bse

nt

for

2 c

on

secu

tive

OT

C v

isit

s

Tran

sfer

red

to

IT

CC

on

dit

ion

has

det

erio

rate

d a

nd

req

uir

ed i

np

atie

nt

care

(IT

C)

Tran

sfer

red

to

oth

er

OT

CTr

ansf

erre

d t

o o

ther

OT

C

Tran

sfer

red

to

Med

ical

Co

mp

lica

tio

ns

hav

e d

evel

op

ed r

equ

irin

g t

ran

sfer

to

med

ical

se

rvic

es (

no

t IT

C)

Card 16