Table 3.
Management of cases of SAM without complications
| Checklist item | N † , % correct |
|---|---|
| Overall % error‐free case management: N, median (range) | 55, 100%*** (66.7–100) |
| 1. Type of child: | |
| a) New SAM case | 32, 58.2 |
| b) Follow‐up SAM case | 23, 41.8 |
| 2. MUAC measurement | |
| a) Keep work at eye level. | 55, 100 |
| b) Remove clothing covering arm. | 55, 100 |
| c) Find approximate midpoint of child's arm. | 55, 100 |
| d) Make sure arm is relaxed at child's side and wrap tape around arm. | 55, 100 |
| e) Make sure tape is flat and not too tight or loose. | 55, 96.4 |
| f) Read measurement number on MUAC strip. | 55, 96.4 |
| 3. Oedema check (in sick children only): | |
| a) Press firmly on top of child's feet for 3 s. | 24, 100 |
| b) Release, and feel pressed spot for indentation. | 24, 95.8 |
| 4. SAM diagnosis: | |
| a) MUAC <110. | 55, 98.2 |
| b) Presence of oedema. | 45, 100 |
| c) Check for SAM with or without complications according to algorithm. | |
| 1. Check for danger signs. | 55, 100 |
| 2. Check for chest in drawing. | 55, 100 |
| 3. Count respiratory rate according to protocol. | 55, 100 |
| 4. Take temperature. | 55, 98.2 |
| 5. Examine for dehydration. | 55, 92.7 |
| 5. Check appetite: Give packet of RUTF to child. | 55, 98.2 |
| 6. If SAM without complications identified: | |
| • Antibiotic given according to protocol | 55, 89.1 |
| • Folic acid given according to protocol | 55, 92.7 |
| • RUTF given and amount calculated according to protocol | 55, 96.4 |
| 7. Delivery of education messages: | |
| a) RUTF should replace the regular diet (except for breast milk) | 55, 92.7 |
| b) RUTF should not be shared with siblings or other children. | 55, 96.4 |
| c) Give frequent feedings with small amount of RUTF (up to eight times per day) | 55, 98.2 |
| d) Any child 6‐12 months who is breastfed should receive breast milk first then RUTF. | 54, 87.3 |
| e) Give adequate amounts of safe water with RUTF. | 55, 96.4 |
| f) Do not mix water in the RUTF packet. | 55, 92.7 |
| g) Give the medicine provided by your CHW two times per day for 5 days. | 55, 92.7 |
| h) Seek immediate advice from the CHW if your child experiences any allergic reactions after consuming RUTF. | 55, 92.7 |
CHW, community health worker; MUAC, mid‐upper arm circumference; RUTF, ready‐to‐use therapeutic food; SAM, severe acute malnutrition. ***P < 0.001; for significance of difference between reported median score and a hypothesized median score of 90% (Wilcoxon signed‐rank test). †Because some items were designated ‘not applicable’ for a particular case, not every CHW implemented every measure on this checklist and for some items N < 55.