Sometimes you miss a target because you have poor spatial and temporal coverage of screening and of recruitment. Sometimes you miss a target because the target is wrong. You have to decide which is the case in your setting. You can do some SQUEAC activities to check this out. Note that such "from recent survey" targets are often inaccurate because the typical survey sample size will result in a SAM estimate of poor relative precision, population estimates can be inaccurate (a particular problem in emergencies and when you have a nomadic population), and the prevalence to incidence conversion factor is often just an informed guess (and the assumptions behind it is questionable when incidence and / or episode length changes thought the year). The targets are better than nothing but, in some cases, will not be much better than nothing.

Hi You could also consider assessment - intervention lag time i.e the lag time between the "last survey findings" and when the program for SAM management was set up. Rogers

Hi you need to review all previous surveys indicators done in catch up area to compare with your survey result if possible some times due to mistake on survey planning by SMART ( inaccurate design effect or precision) or you can do some coverage survey to identify real figure of current nutrition status in Target area Salam

I think also the nutrition surveys done always based on WFH, to some extend its provide misslead figures. it might be no SAM problem there...I'M a right .

I hope that this (i.e. insistence that WHZ is the only true measure of SAM - I still find it odd that we elevate a (normative) sign to the status of a disease) is not still a problem. All SMART surveys should collect MUAC data for needs analysis. I believe that the SMART software now supports this. There are, unfortunately, still a few irrational people kicking against including MUAC in SMART surveys. What may be still be an issue is that the wrong prevalence estimate (i.e. using the WHZ / oedema case-definition) has been used. For MUAC-based programs the MUAC / oedema case-definition should be used. For mixed MUAC / WHZ programs it is tempting to use a combined MUAC / oedema / WHZ case-definition but this will tend to overestimate case-load as screening using WHZ with good spatial and temporal coverage is very difficult to achieve and this will keep coverage down. Some sort of correction (e.g. multiply the MUAC / oedema caseload target by 1.1 to allow for 10% WHZ-only admissions) might make for a more realistic target. This is a roundabout way of saying "Yes. The case-definition used might be wrong and you should check and recalibrate the target accordingly".

Thank you all

Thank you all

Hi Mark, Is there any basis or establish guideline for the above mentioned correction: Multiply the MUAC/Oedema caseload target by 1.1%. Or, this is also another informed guess. In addition, In my three years hands on experience with SAM cases, I found around 80-90% children identified with SAM by MUAC is about 6-30 month of age. 1-2 cases we found with some other chronic medical complications e.g. hernia problem, some has mental abnormalities etc. Is this MUAC is valid for elder children? although we know MUAC is golden standard for identifying acute malnutrition. One programme research in Cambodia by Unicef also validate my suspicion. It would kind enough, if you help me in this regards.