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Emergency standards for SAM/MAM when using MUAC

This question was posted the Assessment and Surveillance forum area and has 2 replies.

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Leah Richardson

Normal user

6 Jul 2015, 11:53

Can one use the same thresholds for SAM/MAM prevalence when using MUAC as the basis for measurement? For example can one equally use less than 15% GAM prevalence to classify significance of the crisis no matter whether you are measuring with W/H or MUAC?

Anonymous 425

Normal user

7 Jul 2015, 13:03

In principle, the threshold is the same. However, there is big difference between MUAC and WHZ prevalence in some geographic/ethnic. In highlanders, both are roughly the same or the difference is just narrow. However, in pastoralists (Long leg), usually the WFH is much higher than MUAC. At the ground level, there is a lot of confusion. The prevalence is usually measured by WFH, supply need during proposal development is calculated based on WFH prevalence but the admission is based on MUAC and as a result there is huge difference in supply estimation. some also advice not to use prevalence using MUAC as it is only mortality predictor.

Mark Myatt

Consultamt Epidemiologist

Frequent user

8 Jul 2015, 10:33

You can use the same thresholds regardless of which indicator you use. These thresholds are rules-of-thumb and have been around for many years (i.e. before we moved to WGS reference which tended to increase prevalence of GAM compared to the older NCHS reference). As rules-of-thumb they need to be interpreted carefully and in context. I am not sure what is meant by "MUAC ... is only mortality predictor" as I see no value in an indicator of "thinness" unrelated to, or only weakly related to, mortality. Such an indicator would lead you to declare emergencies when no emergency existed and to treat healthy older children while excluding sicker younger children (which is what WHZ tends to do). That said ... WHZ still remains a more accepted indicator for prevalence although it is now common to see both prevalence by MUAC and prevalence by WHZ reported. I think WHZ should be retired as we increasing use MUAC for admission.

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