Prevalence of Acute Malnutrition (WfH, oedema)

What: The indicator measures the prevalence of moderate and severe acute malnutrition (wasting) in children 6-59 months. It assesses to what degree (so-called "Z-score") a child's weight for height (WfH) deviates from the weight of a child of the same height and sex in the 2006 WHO Growth Standards. Why: Acute Malnutrition, especially in children, is a severe condition that may lead to death. It is used as a public health indicator for the severity of acute food insecurity or a disease outbreak (diarrhea, malaria) in a given population. When: 1. To assess the impact of severe and/or chronic food insecurity 2. To assess the impact of certain disease outbreak, such as diarrhea, malaria 3. To measure the outcome of CMAM programs

Children's weight and height (alongside with other data) collected by anthropometric surveys using SMART methodology. SMART's website provides all the required guidance, forms, training modules as well as Emergency Nutrition Assessment (ENA) software used for data analysis and reporting.

The cut-off points for moderate acute malnutrition (MAM) are <-2 but >-3 SD; for severe acute malnutrition (SAM) <-3 SD; and for global acute malnutrition (GAM) <-2SD.

Public health use: According to WHO, the prevalence of wasting (< –2 SD) in a population shall be interpreted as:

< 5%: acceptable

5-9%: poor

10-14%: serious

≥ 15%: critical

Disaggregate the data by gender and age groups (such disaggregation is automatically produced by ENA software).

1. The cut-off points for moderate acute malnutrition (MAM) are <-2 but >-3 SD; for severe acute malnutrition (SAM) <-3 SD; and for global acute malnutrition (GAM) <-2SD.
    
2. This indicator relies on accurate age assessment. Since people often do not remember the exact dates of their children’s birth, the data collectors should always verify the child’s age. This can be done by reviewing the child’s birth certificate, vaccination card or another document; however, since many caregivers do not have such documents (and since they can include mistakes), it is essential that your data collectors are able to verify the child’s age by using local events calendars. Read FAO’s Guidelines (see below) to learn how to prepare local events calendars and how to train data collectors in their correct use.
    
3. Always make sure that you understand and follow the local Ministry of Health's official guidance for conducting anthropometric surveys (e.g., regarding submitting a survey proposal for approval; reporting formats; use of 1977 NCHS versus 2006 WHO growth standards/ MUAC cut-off values; etc.).
    
4. Prevention-oriented projects should use this indicator only if their strategy is likely to have an impact on the nutritional (physical) status of the target population. If your project is too short or focuses, for example, primarily on improving agricultural production and improved family diet, use less ambitious indicators on nutritional intake (such as Individual Dietary Diversity Score) or specific nutritional practices.
    
5. In many countries, acute malnutrition is may vary significantly during seasons (e.g. ranging from 5% in the months following the harvest to 11% prior to the harvest). Therefore, if you need to compare your baseline and endline data to assess the result of your work, ensure that the data is collected at the same time of a year, otherwise you will receive two sets of data which say very little about the change your project has (not) achieved.
    
6. With a larger team of enumerators (8-10 people), data collection usually takes about 10 - 15 working days. Training takes 6 days (incl. piloting and standardization test); further time is required for preparing the methodology, hiring enumerators, arranging logistics and reporting.
    
7. Since the differences in the prevalence of acute malnutrition are often very small (e.g. from 7% to 5%), SMART surveys need to be implemented to maximum quality and precision. Always use a small margin of error (2-2.5%). If your team does not have sufficient experience with conducting SMART surveys, contract an in-country or headquarters-based advisor to design methodology, train your team and supervise the survey quality (using quality control checklist, such as the one below, is recommended). Always make maximum use of the guidance available in the resources below.