Coverage of Acute Malnutrition Treatment

Indicator Name

Indicator ID in PRIME

Definition

This indicator is a coverage indicator for community-based management of acute malnutrition (CMAM) and will calculate the proportion of children with acute malnutrition who receive therapeutic care. This is also known as treatment coverage.

Acute malnutrition: includes both severe acute malnutrition (SAM) defined as having a Weight-for-Height z-score more than 3 Standard Deviation below the median of the WHO child growth standards (WHZ < -3SD) and/or MUAC<115mm and/or having nutritional oedema (for OTP coverage), and moderate acute malnutrition (MAM) defined as diagnosed with WHZ >= -3SD and less than -2SD and/or MUAC between 115mm and <125mm (for TFSP).

Weight-for-length is used for infants less than 12 months and that Weight-for-Height is for children 12-59 months, who are able to stand.

Numerator

Number of acutely malnourished children 6 to 59 months who received community management of acute malnutrition in the project area.

Denominator

Total number of children under 5 with acute malnutrition, in the same project area.

Data can come from two different types of sources: Coverage survey for point coverage or program/project data recording.

If coverage survey is not available then proxy coverage can be calculated using number of children 6 to 59 months with acute malnutrition, defined as above, admitted for community management of acute malnutrition over a specified period in the project area, as numerator.

Numerator and denominator should come from the same source—either both from a coverage survey or both from program/project data.

Means of verification include SQUEAC/SLEAC, Census surveys or other population-based surveys that are adequately powered to measure coverage OR use program data recording for proxy coverage by using number of children under 5 with acute malnutrition admitted for treatment over a specified period and estimated caseload of acute malnutrition for the same period.

Coverage assessment methods set out to measure the "treatment" coverage of CMAM programmes, i.e.

at the time of the assessment, the percentage of severely or moderately acutely malnourished children in a defined area (eg a health district or region) who are successfully enrolled in the programme. SQUEAC is a semi-quantitative method that provides an in-depth analysis of barriers and boosters to coverage. It is designed for use as a regular service monitoring tool through the intelligent use of routine monitoring data complemented by other relevant data that are collected on a regular basis. SLEAC is a rapid low-resource survey method that classifies coverage at the Service Delivery Unit (SDU) level. The SDU may be a health centre catchment area, commune, or district. A SLEAC survey identifies the category of coverage achieved by the service delivery unit being assessed. The advantage of this approach is that relatively small sample sizes (e.g. 40) are required in order to make an accurate and reliable classification. For Humanitarian setting Spheres Handbook on Food security and nutrition can be used to assess this indicator:

https://handbook.spherestandards.org/en/sphere/#ch007_004

Indicator Prioritisation

Level of Indicator

Indicator Context Type

Theme

Sub Theme

Cross-Cutting Themes

Common Approach

Total Reach Indicator

Context

Frequency of Data Collection

Unit of Measure

Data Format

Direction of Desired Change

Number of Decimal Points

Indicator is Rounding

Nature

Recommended Disaggregations

CMAM approach is comprised of four components: (1) community outreach and mobilization; (2) outpatient management of SAM without medical complications; (3) inpatient management of SAM with medical complications; and (4) services or programs to manage moderate acute malnutrition (MAM), such a supplementary feeding program.

Other coverage survey related resources can be accessed at https://www.indikit.net/indicator/1-nutrition/36-coverage-of-acute-malnutrition-treatment-services https://www.coverage-monitoring.org/which-methodology-to-choose/

https://www.coverage-monitoring.org/wp-content/uploads/2019/09/SQUEAC-Assessment-Companion_v2aannexes.pdf

WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years