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Minimum SAM levels for coverage assessment?

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Gwyneth Cotes

SPRING

Normal user

23 Apr 2012, 09:56

I recently had a question from one of our field staff, and wasn't sure of the answer - Is there a minimum level of SAM, under which it is not worthwhile to do a coverage assessment, because of the difficulties in finding cases? In contexts where the SAM rate is fairly low, we typically support a more integrated CMAM approach within primary health care service delivery, as opposed to a full-fledged CMAM program, but it would still be worthwhile to have a sense of the coverage in such a context.

Mark Myatt

Consultant Epideomiologist

Frequent user

23 Apr 2012, 11:50

In such settings I would do stages 1 and 2 of SQUEAC. This will give you a lot of information regarding barriers to coverage, treatment seeking behaviours, program performance, program outreach, &c. (stage 1) and identify issues with spatial coverage (stage 2). You can then decide whether a stage 3 survey is needed (it usually isn't but people like to do them anyway).

Cases can be hard to find if prevalence is low but before deciding this you should be aware that wasting is often a "hidden problem". Data from prevalence surveys may underestimate prevalence due to hiding of sick children and because the PPS sample tends to exclude children in smaller communities (where the SAM cases may be). You'll get a good idea of how hard it will be to find cases during stage 2 of SQUEAC.

It is common to do coverage surveys (like CSAS, SLEAC, or stage 3 SQUEAC) during "lean seasons" to make it easier to find cases. SQUEAC stages 1 and 2 do not need large sample sizes and can be done and yiled useful information when prevalence is very low.

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