Table 1 Summarising guidelines in Bangladesh and Kenya
Inpatient and CMAM Bangladesh | IMAM Kenya | CHW strategy Bangladesh | CHW strategy Kenya | |
|---|---|---|---|---|
Admission | 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 | N/A | ||
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 |