The information mentioned in these steps is also indicated on the OTP card which will help you to remember all the essential points to check.

Step 1: Ask about

• Diarrhoea, vomiting, fever or any other new complaint or problem the child may have
• Whether the child is finishing the weekly ration of RUTF.

Step 2: Assess for

• Complications
• Temperature, respiration rate
• Weight, MUAC and oedema.

You should then do the appetite test.

Step 3: Decide on what action to take based on the above follow-up assessment

Refer if there is any one of the following:

• Development of any complications
• The child fails the appetite test
• There is an increase in the level of oedema. For example, if the oedema was only on the feet during admission, and the child has developed increased swelling on higher parts of the body such as the legs or the face
• A child who did not have oedema on the preceding visit is now presenting with oedema on the current visit
• A child without oedema loses weight for two consecutive visits. A child with oedema has abnormal fluid accumulated in the body. As a result, when the condition starts to resolve with the treatment you are administering, and the oedema fluid starts to be lost from the body, you might expect to see a decrease in body weight
• A child with oedema, or one who has recovered from oedema, fails to gain weight for three consecutive visits
• Major illness or the death of the main caregiver so that the child can't be managed at home.

If there is no indication for referral, provide the weekly follow-up OTP services. These include:

• Providing any routine drug that needs to be given on the current visit according to the guidance in Table 10.5
• Providing the weekly ration of Plumpy'nut®
• Making an appointment for next weekly follow-up
• Recording the relevant information on the OTP card.

If the child is absent for any follow-up visit:

• Ask a Community Volunteer to do a home visit and report back to you
• If there is another child with severe uncomplicated malnutrition in your follow-up from the same neighborhood, you may also ask the caregivers why their neighbour didn't come to OTP follow-up.