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Table 1 Summarising guidelines in Bangladesh and Kenya

From: Strengthening the role of community health workers in supporting the recovery of ill, undernourished children post hospital discharge: qualitative insights from key stakeholders in Bangladesh and Kenya


Inpatient and CMAM Bangladesh

IMAM Kenya

CHW strategy Bangladesh

CHW strategy Kenya


Management of Complicated severe acute malnutrition is inpatient

Acknowledges role of CHWs in malnutrition, and in referral to hospital

No acknowledgment of role of CHW

Acknowledges poor linkage between community and hospital levels

Discharge criteria

Upon resolution of complication and to be managed according to CMAM guidelines


Linkage to support at discharge

Transfer slip with description of monitoring plan for specific patient

CHW should discuss inpatient child’s requirements with health worker to understand post-discharge health needs

No specific reference to referral back to CHWs from hospital

Post-discharge support

On discharge children should be sent for follow-up to the nearest public or NGO health facility and followed-up regularly, also enrolled into CMAM, included in growth monitoring sessions at health centres, and enrolled into safety net programmes

According to CMAM: Management in the community health facilities with some patients followed-up at home in case of default or “other challenges”. CHWs can provide home-based care for children with SAM without referral in the absence of any complications.

CHW should discuss with the child’s carer the appropriate home environment to facilitate recovery; and ensure CHW is contactable if there are any concerns about the child’s recovery

“well trained and motivated” CHWs should work at the community-based health facility to monitor children on treatment and assist in the distribution of nutrition therapeutic products.

Follow-up of patients with chronic conditions eg TB.

Malnutrition not mentioned at all

Malnutrition not mentioned specifically at all in the guidelines