SECTION THREE
Proxy Global Acute Malnutrition by MUAC
Definition/RATION/ALE – what does it measure? (max 2 lines)
Proxy Global acute malnutrition (GAM) by MUAC is the prevalence, or proportion, of children ages 6-59 months in a given population considered severely acutely malnourished (SAM) or moderately acutely malnourished (MAM) based on their mid-upper arm circumference measurements.
Methodology for collection – How to collect information for indicator (max 4 lines).
There are six core pieces of anthropometric information generally collected together: sex, age (months), weight, length/height, mid-upper arm circumference (MUAC) and presence of nutritional oedema. The information needed for GAM by weight-for-height include:
- • Sex – Male or Female
- • Age – When collecting data for MUAC, age or proxy age should be captured to (1) exclude children outside the 6-59 month range, and (2) minimally determine whether the child is either less than 2 years of age, or 2+ years of age.
- • Mid-Upper Arm Circumference (MUAC) – Measured in cm to the nearest 0.1cm, or in mm to the nearest 1mm. Measured with a standard child MUAC tape at the mid-point of the upper arm while the arm is fully extended. MUAC is not valid for children under 6 months of age, as they may realistically have a low MUAC but not be malnourished.
- • Nutritional oedema (bilateral pitting oedema) – Characterized by swelling of the feet of the malnourished child. Varies in severity but generally starts in the feet/legs, progresses to the arms and finally the face. To test: Both of the child’s feet are held by the tester. A moderate amount of pressure is applied to the top of both feet simultaneously for three full seconds. If there is nutritional oedema, the impressions/indentations on the skin will not return immediately (think of putty or dough that slowly returns to its original form.) This must be present on BOTH feet to be linked to malnutrition. If only on one foot, it may be due to other clinical reasons.
Methodology for analysis – How to analyse (Max 4 lines)
Visual demonstrations for thresholds
How to interpret: Urban v. rural, gender
Determining Nutritional Status
- • GAM is determined by the proportion of children either with SAM or MAM.
- • A child is classified as SAM if they: (1) have a weight-for-height z-score (WHZ) of <-3 SD, or (2) the presence of nutritional oedema.
- • A child is classified as MAM if they: have a WHZ of >= -3 SD and <-2 SD.
- • GAM = (# children with SAM + # children with MAM)/( # total children 6-59 months)
Recommended Thresholds According to IPC Acute Malnutrition, Nov 2018
- • Phase 1 (Acceptable) – Proxy GAM by MUAC is <5% and previous survey data suggests GAM by MUAC is typically lower than GAM by WHZ.
- • Phase 2 (Alert) – Proxy GAM by MUAC is <5% and previous survey data suggests GAM by MUAC is typically lower than GAM by WHZ; OR proxy GAM by MUAC is 5-9.9% and previous survey data suggests GAM by MUAC is typically higher or the same as GAM by WHZ.
- • Phase 3 (Serious) – Proxy GAM by MUAC is 5-9.9% and previous survey data suggests GAM by MUAC is typically lower than GAM by WHZ; OR proxy GAM by MUAC is 10-14.9% and previous survey data suggests GAM by MUAC is typically higher or the same as GAM by WHZ.
- • Phase 4 (Critical) – Proxy GAM by MUAC is 10-14.9% and previous survey data suggests GAM by MUAC is typically the lower than GAM by WHZ; OR proxy GAM by MUAC is >15% and previous survey data suggests GAM by MUAC is typically higher or the same as GAM by WHZ.
- • Phase 5 (Extremely Critical) – Proxy GAM by MUAC is >15% and previous survey data suggests GAM by MUAC is typically the lower than GAM by WHZ
Notes on indicator –
What does the indicator not tell us.
How long is it reliable for?
- • Prevalence of GAM by MUAC should be referred to as “proxy” GAM, as it is not a true representative indicator of malnutrition in the population. This is because MUAC measurements are more sensitive younger children (under 2 years of age) and will likely not detect older children that are malnourished by the WHZ criteria.
- • Exact age is not needed for MUAC, however MUAC is more sensitive to detect acute malnutrition for younger children. If the sample is over-represented with under 2 year old children, it will give a falsely high proxy GAM.
- • Children that are classified as SAM have been shown to be at an increased risk of mortality.
- • GAM by WHZ is considered the main indicator for determining nutritional status of a population. Therefore under the IPC Acute Malnutrition Classification, the IPC Phase is only determined by MUAC in the context of the relationship between MUAC and WHZ. For example, a proxy GAM by MUAC of 8% would indicate Phase 2 in a district where WHZ is the same or lower than WHZ. In a district where proxy GAM by MUAC is typically less than WHZ, a proxy GAM of 8% could indicate Phase 3. Previous survey data should be assessed in a given population to determine this relationship.
- • The indicator does NOT directly tell you whether the cause of malnutrition is related to health or food security.
- • The indicator does NOT tell you trends in acute malnutrition over time as it is generally captured in cross-sectional surveys.
When to use it/when not to use it:
- • Often used in mass screenings to actively identify acutely malnourished children and refer them to services.
- • Used in rapid assessments to identify acutely malnourished children, either through random or exhaustive sampling.
IPC Categories:
2nd level outcome indicator
M&E: IMPACT, OUTCOME, OUTPUT, PROCESS
Impact/Outcome
