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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 5 replies.

### 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.

### 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.

### Abdul-Razzaq Zaid Ahmed Musaed

Nutrition Surveillance Officer

Normal user

19 Feb 2023, 18:51

Thanks, dear Haliu for your detailed response and for providing clarification