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Thresholds for CMAM response based on SAM prevalence

This question was posted the Management of wasting/acute malnutrition forum area and has 2 replies.

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Kate Golden

Senior Nutrition Advisor/ Concern Worldwide

Normal user

18 Aug 2009, 13:12

I am wondering if anyone is using or has come across any guidelines (perhaps in draft form) for the level of SAM prevalence (in NCHS or new WHO standards) that indicate a nutritional emergency and tirgger a response such as CMAM. The UN uses its 10% GAM threshold, but I haven't found any guidleine that mentions SAM prevalence. I seem to remember the FSAU had SAM as one of its criteria in an earlier version of its classification tool for food security emergencies, but I haven't been able to find it since, and only GAM is included in the more global Integrated Food Security Phase Classification (IPC) assessment tool. I realise a context analysis to establish the relative burden of different diseases and acute malnutrition is the gold standard in each situation, but I'm wonderingt if there has been any agreement on what level of SAM prevalence should almost definitely trigger an immediate reponse, and then, even beyond emergencies, what level of SAM might indicate that it is a significant public health burden and justify advocacy for the inclusion of CMAM in the government's essential health package. I realise that in my head I have been using very roughly above 1% as a general benchmark for SAM being a significant burden (based on NCHS WHZ <-3 and or oedema) and above 2% venturing into slightly alarming, above 3% being an emergency, but that is really not based on anything substantial. It is also hard to justify these benchmarks given the lack of precision on SAM estimates from clustered nutrition surveys (it's a bit easier if there is a series of surveys to get the general sense over time or to single out a seasonal peak). I wanted to hear if I have missed any major guidelines and/or what other people are using. It seems more and more agencies and governments are considering implementing CMAM without the supplementary feeding component, yet we are sort of basing our decisions on a classification tool hinging on GAM levels. Any thoughts would be greatly appreciated. Thanks, Kate

Elise Becart

Normal user

16 Sep 2009, 19:39

Today it is more and more a concern for everybody reagrding the SAM threshold; one of the reason being the CMAM approach. The SAM thresholds, you mentionned, are usually what I have in mind however I think it remains important to check within SAM result what % of kwashiorkor you have. The diagnostic of kwashiorkor is still doubtful and in case you have more than 1% of kwashiorkor, take time to look at closely each case by crosschecking weight, height, Muac. It is one of the problems in DRC for instance. In any case, I think it would be relevant to have an official SAM threshold especially since the nutrition programs are changing to WHO standard meaning targeting more severe acute malnourished children. The Sphere committee is currently working to update the nutrition chapter and this isssue should be taken into consideration as it is part of the emergency classifications. Thanks Elise

Tarig Abdulgadir

CMAM Specialist / UNICEF

Normal user

16 Sep 2009, 23:14

Dear, i do agree with your question, however if we considered new growth standards WHO/UNICEF joint statement we will realize that it is impact will affect the pevelence of SAM as some cases considered befoe as MAM will be consideed now as SAM and off course the new gowth standad ( included in CMAM appoach) will not reflect the same prevelance reflected by nutrition survey hence there is a recommendation to use same criteria for admission in survey and as you know survey result is key step in deciding plan of intervention so this is a thing need to be adapted and considered , now in Sudan as we are a head in adopting CMAM approach, we still have mixed guidance from SAM and CMAM approach and applying CMAM is really interesting as it would require adaptation and updation of many guidelines at country and global levels e.g. in Sudan there will be need to update national nutrition survey guidelines, SAM guidelines and SFP guidelines. just to share my thinking with you

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