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Tracking SAM Monitoring child nutrition based on arm circumference measurement

Tracking SAM Monitoring child nutrition based on arm circumference measurement . Dipa Sinha. Severe Acute Malnutrition. Severe Acute Malnutrition (SAM) through Nutrition Rehabilitation is defined by:

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Tracking SAM Monitoring child nutrition based on arm circumference measurement

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  1. Tracking SAM Monitoring child nutrition based on arm circumference measurement DipaSinha

  2. Severe Acute Malnutrition • Severe Acute Malnutrition (SAM) through Nutrition Rehabilitation is defined by: • a very low weight for height (below –3Z scores of the median WHO growth standards), • by visible severe wasting, • or by the presence of nutritional edema • MUAC <115mm (for referral and for CMAM) • SAM children have a mortality risk that is substantially higher than that of normally nourished children • The median under-five case-fatality rate for SAM typically ranges from 30% to 50%

  3. SAM in India • NFHS 3 data for India shows that 6.4% children under five years of age have a weight-for-height Z-score (WHZ) which is less than -3SD • i.e. about 8 million children in India are at any time severely acutely malnourished. • Main strategy being adopted for treating SAM in different states is through the setting up of NRCs under the NRHM • 1898 NRCs have been set up across States for treatment of acute malnutrition

  4. Falling Between Two Stools* • ICDS identifies children who are severely underweight (i.e. those with weight for age z-scores less than -3SD) • NRCs are for the treatment of children who are severely wasted (i.e. those with weight for height z-scores less than – 3SD). • Data from NFHS (and CARE – INHP) shows that about 36% of SAM children are not severely underweight and 62% of severely underweight children are not SAM * V Prasad, D Sinha and S Sridhar (2012)

  5. Mid-upper Arm Circumference • MUAC being recommended as a screening tool as • Easy to use • Not much training required • Community understands • Identifies children who are at highest mortality risk • “The prevalence of SAM, i.e. numbers of children with SAM, based on weight-for-height below -3 SD of the WHO standards and those based on a MUAC cut-off of 115 mm, are very similar.” [WHO UNICEF Joint Statement, 2009]

  6. MUAC vs. WHZ • Hungama Survey

  7. MUAC vs. WHZ - 2 • Madhya Pradesh VikasSamvad Study – 4.9% SAM on the basis of MUAC and 8.5% on the basis of WHZ

  8. Operational Questions that need to be addressed • What anthropometric measurements need to be carried out by the AWW at the village level? • What should be the referral criteria for NRCs? • What should be the exit criteria for NRCs? • What should be the components of community based management of malnutrition and how should this be organised? • How is it different from ‘CMAM’?

  9. Issues for Discussion • Reliability and validity of MUAC as a screening tool in chronically undernourished populations needs to be studied (in the MP sample 57% stunting). • Pediatric Body Composition data is not available • The mortality risk studies are not based in India • Higher cut-offs of MUAC include more children

  10. Issues for Discussion - 2 • Need for comprehensive strategies for addressing malnutrition • Address every child and all forms of malnutrition • Is height really impossible? • Preventing SAM and other severe malnutrition • Growth Monitoring and Protocols for Management need to be put in place

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