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SQUEAC/coverage survey stage I routine monitoring data analysis

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Anonymous 5324

Nutrition and Health Officer

Normal user

5 Oct 2018, 13:06

Dear all,

We are planning to conduct a SQUEAC coverage survey in one of the refugee camps to estimate the responses coverage and to identify the services BBs. To identify cases, MUAC and WFH have been used, with the following cutoff points for SAM and MAM. SAM: either of MUAC<115mm or WFH<-3z score and any grade of bilateral pitting oedema. MAM: either of MUAC ≥115 mm - <125mm or WFH ≥-3Zscore - <-2z score, and no bilateral pitting oedema.

There is active case finding using deployed community volunteers, and these volunteers use only MUAC, not WFH. So, any child identified <125mm by community volunteers, has been referred to nutrition centers without considering his/her WFH at outreach level.

However, as MUAC and WFH do not have an exact correlation, “Elevated MUAC” has been applied since two years back. Meaning that young (6 - <24 months) and older (≥24 -59 months) children with MUAC <140 and <150mm, respectively have been referred to nutrition centers for WFH measurement. With this procedure, above 60% of the admitted cases are based on WFH , the rest due to MUAC and oedema. In addition, both MUAC and WFH are used to identify cases to discharge from the program as cured and others types of program outcome.

For such program implementation context, where MUAC and WFH are both applicable to identify and to monitor cases, when we conduct SQUEAC stage I quantitative routine monitoring data analysis, do we need to analyse the admission and discharge data separately based on by which tool the case is identified during admission and discharge? Meaning that analyzing those admitted by MUAC (and or WFH) as the first group and those admitted only by WFH (but not SAM by MUAC) as the second group.

In short, knowing if there is any program performance difference of MUAC and WFH (like to be cured, to be defaulter, Length of stay (for both to be cured and defaulter), age, and others), will help us to understand better about the services BBs?

With best regards,

Lio

CMAM advisor

Technical expert

9 Oct 2018, 09:00

Dear anonymous,
I think there is no harm in analysing the performance indicators based according to the criteria of admission; however, I am not sure that this will tell you a lot about coverage barriers considering that children in the programme are covered. However, it might give you some hints about potential difference in some indicators like mortality or defaulting rate. If this is the case, you can than dig the reasons. I personally never did the difference of the performance indicators based on admission criteria but it will be interesting to see if you point out one difference and the reason why so.
What instead really worries me is your screening/admission method in which you report having at least 40% of rejection. I don’t know in which country your IMAM programme is implemented but it is the first time in years that I hear that a two stages screening/admission is still used (using a high MUAC cut off to get WFH). This procedure is well known to “kill” coverage because of the “rejection” element which makes people unhappy, raises a bad opinion about the programme and people are reluctant to bring the child back to the health facility even if his nutritional status deteriorates. This practice was one of the first banned when CMAM was implemented. In many countries, WFH is also an admission criterion but it is called “indirect admission” because WFH is taken only at the health facility level (mainly for children that don’t qualify for MUAC admission). Basically, what I am saying is, I think you should indeed proceed with undertaking a coverage survey and it will be important to analyse: 1) the coverage estimate and, more important, 2) the barriers to access; I would not be surprised if your coverage is low and the rejection the main barrier!

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