Recntly I am seeing inclusion of MAM in the case definition and use of z-scores during the Wide Area Survey but not Small Area Survey. However, these are not covered in the SQUEAC guidance or on the Monitoring Framework tools or have been used previously even when admissions included z-score criteria. Is it necessary to now start using z-scores in our case definitions during Wide Area Surveys? Why and how did this shift happen? I had not planned on using z-scores in the case definition, but now do I have to? Does the following case definition look good based on inlusion of these two factors?:
SAM Covered: MUAC <11.5, WHZ <-3 and/or Bilateral pitting oedema, with ration cards showing visit within the last 3 weeks AND/OR showing RUTF sachet
SAM Non-Covered: MUAC <11.5, WHZ <-3 and/or Bilateral pitting oedema, no ration card OR ration showing last visit > 3 weeks ago (default) AND no RUTF
SAM Recovering: OTP cases with MUAC ≥ 11.5 AND WHZ ≥ -3 with ration cards showing visit within the last 3 weeks AND/OR showing RUTF sachet
MAM Covered: MUAC <12.5 cm to ≥11.5cm or -2 > WHZ ≥ -3 with ration cards showing visit within the last 5 weeks AND/OR showing RUSF sachet
MAM Non-Covered: MUAC <12.5 cm to ≥11.5cm or -2 > WHZ ≥ -3, no ration card OR ration showing last visit > 5 weeks ago (default) OR no RUSF
MAM Recovering: MUAC ≥ 12.5 AND WHZ ≥ -2 with ration cards showing visit within the last 5 weeks AND/OR showing RUSF sachet.
I would apprecite if someone with expertise can take a look and give some insight.
Hello Bushra,
The addition of WHZ for SQUEAC in a small area is feasible since it is like we collect anthro data during SMART surveys. This would mean you will need to conduct a standardization test during the training. The case definition of confirming RUTF sachets is a good idea but the reality on the ground they may not be keeping any sachets. You may have to carry sample sachets to confirm what they used to receive. If the area has both TSFP and OTP you will need to carry sachets of RUTF and RUSF
Answered:
9 months agoHello,
The guidance for SQUEAC and SLEAC has not changed. However sometimes it is appropriate to assess WFH z-score as well as MUAC and oedema during small area and wide area surveys. It depends on the referral criteria used by community outreach workers (CHWs or CHVs) in the context in which you are conducting the survey. Referral criteria during SQUEAC and SLEAC assessments should always reflect the criteria for screening in the national CMAM protocol of the country.
For example, in some countries and contexts, CHWs or CHVs refer children whose MUAC falls under a certain threshold to health centres to receive a full anthropometric measurement (i.e. WFH z-score). This is because they are deemed to be "at risk" of SAM or MAM and may be SAM or MAM based on WFH z-score but not by MUAC and/or presence of oedema. In this context, it would be appropriate to follow national protocols and to assess all three anthropometric criteria during a small and wide area survey. Including WFH z-score measurement in SQUEAC or SLEAC surveys adds time and resources to surveys so should be avoided wherever possible.
If the national protocol states that children should only be referred to SAM or MAM treatment programmes if their MUAC falls below the standard admission criteria (<115mm for SAM or 115-124mm for MAM), or if they show signs of oedema, it is appropriate to only use MUAC and oedema during the small and wide area surveys.
Answered:
9 months ago