Community-based

Where community-based therapeutic care (CTC) exists, active case finding and screening for SAM takes place in the community.

 
Children with SAM without medical complications are treated in the community in an outpatient therapeutic programme. Children identified with SAM with poor appetite and/or medical complications, or who are under 6 months, are referred from the community to an inpatient health facility or Stabilisation Centre for admission.

Components of CTC

There are several important components of community-based therapeutic care (CTC):

Community-based screening

Acute malnutrition is identified through screening in the community or by self-referral. Screening should use MUAC (mid-upper-arm circumference), which is a simple, easy to use, low cost method. Communities must be mobilised to support screening and to ensure an active, volunteer labour force.

Outpatient therapeutic programme (OTP)

Children identified with severe acute malnutrition without medical complications should receive therapeutic treatment in an OTP, run by health workers in local health facilities or community buildings. Outpatient therapeutic treatment follows the same principles as inpatient therapeutic treatment.

Ready-to-use therapeutic food (RUTF) is provided along with a broad-spectrum antibiotic. Deworming and other medicines may be given as needed. These are taken at home and the child attends the OTP site weekly for check-up and for more supplies of RUTF. Health education is also provided. Click here to find out: What is RUTF?

Supplementary feeding programme (SFP)

Children identified with moderate acute malnutrition with no medical complications are supported in an SFP which provides dry take-home rations or Supplementary RUTF and simple medicines. This prevents deterioration to SAM and reduces mortality. Food distribution is weekly, every 2 weeks or monthly usually from the same location as the OTP. Where possible the rations are based on locally available foods.

Good linkages between inpatient health facilities (hospitals or Stabilisation Centres) and community-based centres are essential to ensure continuity of care. Children discharged from inpatient health facilities should be referred to an OTP close to where they live for regular follow-up.

See our resources pages for more information on community-based management.