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Post a reply: Is it valid to use similar cut-off points for prevalence of wasting using z scores for different countries and contexts?

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Hi there, II faced this situation and want to to hear your ideas. We have a programme running for long, but the GAM rates during the hunger gap based on WHO standards 2006 is unacceptably high in all surveys: for example the Gam estimate is around 18 (95% C.I. 15.7 – 20.8). When we see the GAM using MUAC it is consistently below 10 percent for all the surveys (half of the z score results). There is no coverage survey to see the coverage of the programme, but some of the results are in direct contrast with the situation on ground. One of this surveys was conducted in an urban setting with a very good program (programme indicators meeting the sphere minimum standard except default rate). Based on the WHO classification this level of GAM are critical, but based on my experience from Ethiopia this levels are observed only on near famine situations like the current Horn of Africa El nino droughts or in pastoral communities like Somalia. Therefore, I am wondering are this z scores really telling me the situation on the ground? Is this valid to say the situation ‘critical’ when you have a well-run CMAM program? Moreover, the program admission and discharge is done by using both MUAC and z scores (WHO). The NCHS results are similarly 'unacceptably' high. I have been reading the article '“Fluctuations in wasting in vulnerable child populations in the Greater Horn of Africa.” S Chotard, J Mason, N Oliphant, S Mebrahtu and P Hailery. linkFood and Nutrition Bulletin, vol. 31, no. 3 (supplement), 2010.' The research paper tryies to come up with different cut off points according to the local context, rather than having a single cut off points for all countries. I really want a discussion on this and an answer for my questions from you.
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