An MSF Therapeutic Feeding Programme (TFP) is intended to reduce the mortality rate of severely malnourished individuals within the entire affected population including children, adolescents, elderly and adults.

Treatment is conducted in a Therapeutic Treatment Centre (TFC) with both specialised diets and medical treatment as well as close individual follow-up. Proper treatment and follow-up are crucial to avoid the death of the patient. The main objective is the reduction of the mortality of the severely malnourished individuals.

The treatment is divided into two distinct Phases. Phase I of a TFC usually comprises of a 24-hour intensive care unit where medical complications are treated and where nutritional treatment (low kcal and protein content) is started. This comprises of eight meals per day, over 24 hours, with feeding day and night.

When the patient has passed the critical phase, they will be transferred into the Phase II section which is preferably a day-care unit, in service eight to nine hours a day, or a 24-hour unit. During Phase II, the patient will receive four to six meals per day of high energy content with nutritional and medical follow-up.

Design

The design of the programme should be adapted in each situation according to the number of beneficiaries and the resources available and the practical feasibility (needs and constraints). In large food crisis and famine situations, like in the Gode area, the number of severely malnourished individuals can be very high. Under such circumstances, the first aim the TFC is to cover, as rapidly as possible, the largest number of severely malnourished individuals.

This requires starting with a simplified design and approach: structure and functioning of the centre; only day-care; focus especially on simple routine treatment properly given to all the beneficiaries. Normal protocols of treatment and a 24-hour intensive units will be implemented later when the situation is under control. Structures would likely be divided between adults and children as they do not have the same management.

Treatment

The treatment of severe malnutrition is divided in two phases: Phase I (initial treatment) The specific objectives are the treatment of the medical complications and restoration of the normal metabolic functions including:

• medical treatments and prevention of dehydration, infections, hypothermia, hypoglycaemia, heart failure, very severe anaemia etc. This involves a nutritional treatment based on a low energy Kcal and protein diet content (in total 100 Kcal/kg/d for children, 40 Kcal/kg/d for adults), given in frequent fractionated meals ( 6-8 meals per 24-hours)
• and a very close daily monitoring of the patient The treatment in Phase I is usually provided in a 24 hours care unit. In large food crisis, famine or high insecurity situations (as Gode or Danan), we will offer only on the form of a day care centre.
• Phase II (Rehabilitation or catch-up growth)
• The specific objectives of Phase II are the rapid weight gain of the patient (for children: 10-20 g/kg/day)

TFC and exit, This is accomplished by:

• a nutritional treatment based on a high energy Kcal diet divided in four to six meals a day
• medical treatment
• the regular monitoring of the patient

the development of emotional and physical activities The treatment in phase II is usually provided in day-care units. Phase II may be offered on the form of 24 hours care, when it is more convenient for the families living faraway. An other alternative is to set-up, next to the TFC, night-shelters to accommodate the families. When the patient has reached the recovery criteria, he will be discharged of the TFC and refer to the Supplementary Feeding Centre, when available, for consolidation phase.

What food is used?

In Phase 1 the diet is composed only of F 100 meals in Phase II there are also other kind of meals such as porridge, biscuits, local meal, ready-to-use therapeutic food.