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GAM vs Mortality rate

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Anonymous 490

SMART Survey Consultant

Normal user

11 May 2015, 09:29

When the GAM is high in a nutrition survey, IS THE MORTALITY RATE supposed to be HIGH TOO?

Mark Myatt

Consultant Epideomiologist

Frequent user

11 May 2015, 15:47

This might be expected but may not occur.

A high GAM prevalence is likely to come before high mortality. This will typically be the case as GAM and SAM prevalence increases and there is no prevention and treatment interventions.

The peaks in GAM prevalence and mortality may coincide. This may be the case when wasting is due, in most part, to infection. Note that GAM by MUAC is likely to be due to infection as peripheral tissue is catabolised in the response to infection.

These two scenarios are what might be happening rather than what is observed to be happening. A problem arises because GAM prevalence is usually "snapshot" of the situation over the few days of data collection but mortality is often estimated for the period before (sometimes quite a time before) the survey used to estimate GAM. This means we do not usually have contemporaneous data for GAM and mortality. It is mistake to think that the two estimate relate to the same time. A number of solutions have been suggested to reduce the recall period of retrospective mortality survey but none are in common use at present. Note that retrospective mortality surveys present an average rate for the recall period and cannot tell you much about change. See this thread which also discusses the relationship between GAM prevalence and mortality estimates.

Additionally, mortality surveys are not easy to do well and are subject to a number of biases that can be difficult to avoid. Survival bias is a particular problem which will cause mortality to be underestimated.

In short ... take care with interpretation ... the data may do not relate to the same time period and the mortality estimates can be biased.

I hope this helps.

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