This is for MBBS students, preparing for paediatrics OSCE examinations. I hope it helps.

1. Case 4

2. • Tanaka is a 14-month-old boy who was admitted to the malnutrition unit 2 weeks ago. He was brought in by
his father with a history of generalized body weakness and poor appetite. Tanaka’s mother passed away 6
months ago after a short illness. He has two brothers aged 3 and 5 years. They stay in a single rented room in
Mbare. Father does piece jobs and admits to regular drinking.

3. Anthropometry
• Weight – 5.5kg, length - 67 cm, MUAC – 11.2 cm, HC – 45 cm
• No oedema
 Interpret Tanaka’s anthropometry

4. Progress on the ward
• Tanaka was treated for NOSAM secondary to early weaning and poor diet. He was also diagnosed with
pulmonary TB a week into his admission and was commenced on TB treatment. You are now considering
discharge.

5. • What are discharge criteria for children with SAM admitted to a stabilization centre?
•
• What pre-discharge interventions need to take place before Tanaka can be sent home?

6. • Discharge patient if;
- Appetite has returned that is, the patient eats at least 75 percent of allocated RUTF as observed for a
period of 24 hours; and,
- Medical complications are resolved or controlled; and,
- Oedema is resolving

7. - Discharged patients should be referred immediately to outpatient therapeutic care for continued treatment
and follow up – discharge with a one or two week supply of RUTF depending on the availability and arrange
for a follow up appointment either at OPD or at their closest OTP centre if preferred
- Children under 6 months of age should NOT receive RUTF. If breastfeeding is not possible, provide
replacement feeding according to national guidance
- Every patient should be offered an HIV test before discharge
- The infants should be checked for immunisations and other routine interventions

8. - Child health cards must be updated with most recent anthropometric measurements prior to the discharge
- The caregivers should receive comprehensive nutritional counselling, as well as counselling covering topics
such as hygiene, red flag signs of illnesses, family planning.
- The mothers and care giver of infants should be linked with needed community-based follow up and
support such as routine growth monitoring
- Follow up of these children is very important to ensure they do not become malnourished again

9. • What should his caregiver counselled on?
• What is a long-term management for Tanaka and his family?

10. • What is 4-star diet?