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Preference for combined GAM rate over GAM by MUAC or WHZ score

This question was posted the Assessment and Surveillance forum area and has 4 replies.

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Anonymous_G_W_40

M40ReAnalytics

Normal user

21 Mar 2022, 09:56

Hello,

Are there any circumstances where one indicator e.g. GAM rate by MUAC or GAM rate by WHZ score can be superior in application compared to a combined indicator e.g. combined GAM rates? 

Hailu Wondim

Senior Program Manager (SMART Initiative)

Technical expert

30 Mar 2022, 12:51

Where programing is done using all criteria, cGAM would be more relevant for planning and caseload estimation, where either GAM by WHZ or MUAC would not be very informative, as in most scenarios, there is a notable difference between the two. For example, in determining the coverage of the CMAM program in Yemen, determining the coverage based on one of the two would be punitive to the program which admits with WHZ, MUAC and Oedema. we therefore used the cSAM for that. 

Anonymous_G_W_40

M40ReAnalytics

Normal user

30 Mar 2022, 16:03

Thank you for the clarification, Hailu. Have there been instances where one indicator(GAM by MUAC or WHZ) has been used as an indicator as opposed to cGAM? 

Such as when one indicator is way greater than the rest. Such as cGAM-10%, GAM by MUAC-34% while GAM by WHZ-12.9%

In this case, would there be a preference for MUAC over the rest?

Hailu Wondim

Senior Program Manager (SMART Initiative)

Technical expert

4 Apr 2022, 19:20

Thanks a lot for the follow up question: cGAM prevalence is prevalence of malnutrition with MUAC and/or with WHZ without double counting children who are malnourished with both criteria. cGAM prevalence will not be lower than GAM prevalence by WHZ or GAM prevalence by MUAC in most cases. In very rear cases (example given below) GAM prevalence by WHZ or MUAC might be slightly higher. In any case if you have nutrition program admitting using both criteria it is preferable to use cGAM for your case load calculation and estimation of the number of children malnourished in an area.

Example of cGAM prevalence lower than GAM prevalence by WHZ: 

When a child’s weight and height measurement is missing but his/her MUAC is measured the denominator for GAM prevalence by WHZ will be lower than the CGAM prevalence denominator. Hence, the prevalence of GAM by WHZ score may slightly be higher than Prevalence by cGAM. IN the below data set cGAM is 14.7% and GAM by WHZ and/or Oedema is 14.8%. This is because cGAM denominator is N=306 whereas GAM by WHZ denominator was N=305 where both had same number of cases (n=45) in the numerator - that is the main reason where cGAM was slightly lower.

Data set: https://drive.google.com/file/d/1kux90reyk32MtETiY1xl_14N1r_FEHIT/view?usp=sharing

Anonymous_G_W_40

M40ReAnalytics

Normal user

7 Apr 2022, 17:05

Thank you for the clarification.

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