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Why GAM (SAM+MAM) Rates are high in lowland areas more than highland areas?

This question was posted the Prevention and treatment of severe acute malnutrition forum area and has 7 replies. You can also reply via email – be sure to leave the subject unchanged.

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Tammam Ali

H&N Project Manager/Relief International

Normal user

14 Feb 2019, 11:54

Dear All,
Do you have any research, findings, or any related article explaining scientifically why GAM rates are higher in the lowland areas (Coastal areas) than in the highlands?. For example in Yemen I see through SMART surveys and EFSNA surveys GAM rates are higher in the lowlands than highlands. I don't think it is because of population density. What do you think?
Best

André BRIEND

Frequent user

14 Feb 2019, 14:00

Dear Tammam,

Your observation is very interesting and deserves further exploration.

Weight-for-height (WFH) is influenced by nutritional status and also by body shape. It has been shown in Brazil in a population with high chest circumference, that WFH is higher than expected. See:

Post CL, Victora CG. The low prevalence of weight-for-height deficits in Brazilian children is related to body proportions. J Nutr. 2001;131:1290–6.

In populations living in altitude, chest circumference is usually higher, as an adaptation to low O2 pressure.

If the populations you are talking about live at 2000 m or higher, they may have a larger chest circumference and as a result a higher WFH. This is something to check. This should not be too difficult; you should measure the chest circumference in a sample of children in lowlands and highlands and compare the relationship. You are welcome to exchange more on this with me outside this forum.

Fahd yahya Moqbel Alkhawlani

IYCF project Officer Save the children internatio

Normal user

15 Feb 2019, 01:36

Prevalence of global and severe acute malnutrition based on weight for height z-score considered
the highest in low land areas with GAM of 19.8% (16.6 - 23.4 95% C.I.) and SAM of 2.9% (1.8 -
4.5 95% C.I.) Compared with GAM of 9.2 %( 6.2 -13.4 95% C.I.), and SAM of 1.0 %( 0.4 - 2.5
95% C.I.), in mountains areas. Statistically there is significant difference in the GAM prevalence
between Low land and mountains in 2014, p 0.0001.
Global acute malnutrition in Low land remains “critical” as it exceeded the emergency threshold
at 15%. Mountains prevalence remains “Poor” based on WHO classification as well. The rates
might increase following the seasonal patterns therefore, monitoring of the situation is warranted.
Weighted prevalence of global acute malnutrition based on weight for-height z-scores (and/or
oedema) is 11.8% for the whole governorate. The weighted analysis is used to correct the bias
of a non-representative sample. The distribution of the sample for each stratum is not proportional
to the sample calculated for the entire population.
Comparison between the WHO GAM rate of 2012 and 2014 for both highlands and low land;
Statistically there is non- significant difference between GAM rates in low land areas 21.6% (18.8
-24.7 95%CI) and 19.8% (16.6 – 23.4 95%CI) respectively using the “overlapping confidence
interval test” and as well the statistical test using “two-survey” calculator shows p 0.544. See
figure 3.2
Mountains GAM rates for the same period 2012 and 2014, 9.3% (7.2 -12.1 95%CI) and 9.2% (6.2
-13.4 95%CI) respectively shows non-significant difference as the confidence interval is
overlapping, and using “two -survey” calculator with p 0.645 which confirm the statistical test of
the confidence. Rates of malnutrition in both low land and Mountains remain at same level with no
changes in terms of GAM despite the on-going interventions in High governorate as shown below
in figure 3.2
Figure 3.2 Comparison between GAM and SAM prevalence 2012 to 2014:
Low land Low land High land High land
2012 2014 2012 2014 GAM - SAM

Prevalence of severe wasting is noticed higher (5%) in the age of 6 – 17 months among children
living in low land compared with their counterpart of the same age in the mountains zone who
were reported 1.5%. Moderate wasting also noticed high among children aged 54-59 months with
26% in low land compared to 9.7% in mountains. Severe wasting among children 6-17 months is
comparable to current knowledge for infants and young children as they have the highest
micronutrient requirements relative to their energy intake and are more susceptible to increased
infection as they begin exploring their environments as well poor weaning practices.
Regards
Fahd yahya

Tammam Ali

H&N Project Manager/Relief International

Normal user

20 Feb 2019, 08:18

HI Andre,
Thanks for your reply and hints about measuring the chest circumference. I don't think we did this measurements before for comparison. Please advise how to communicate with you

Tammam Ali

H&N Project Manager/Relief International

Normal user

20 Feb 2019, 08:38

Hi Fahd,
In your reply I did not read a reason why GAM rates are higher in the lowlands areas.

André BRIEND

Frequent user

20 Feb 2019, 13:39

Dear Tamman,

You can ask my email address to the moderator of this forum or find it in this paper:

https://www.ncbi.nlm.nih.gov/pubmed/21951349

Fahd yahya Moqbel Alkhawlani

IYCF project Officer Save the children internatio

Normal user

21 Feb 2019, 00:06

You are welcome Dr, Tammam
I think most of the causes of GAM (SAM &MAM ) Rates are high in lowland areas more than highland areas As follows:-
- Lack of awareness of breastfeeding exclusive from the first hour - 6 month ( IYCF )
- RBC activity is weak due to the availability of oxygen in the lowland areas 
the highland has low of oxygen and high HP
- the Peoples in the lowland have poverty (poor) more than highland
So .. the Pregnant women and lactating mothers they didn't get enough of food that contained whole ingredients..
the Poverty is a major cause...
- Loss of fluid from the body due to the sweat
- Most of the housing in lowland areas there the sanitation is incorrect
regards ,,,,
Fahd yahya
Note. .. I hope to correct you the error in my opinion

Tammam Ali

H&N Project Manager/Relief International

Normal user

21 Feb 2019, 08:16

Thanks Fahd for your points. the points you raised may be the findings of any study and I don't think we have this study in place in Yemen
Best

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