| Indicator ID | H16 |
|---|---|
| Indicator full statement | The percentage of children under 5 years old diagnosed with Global Acute Malnutrition (GAM) (both Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM)) without complications who have recovered during a specified period. |
Purpose
| Importance | This indicator measures the effectiveness of nutrition interventions in treating children with GAM where Tdh is conducting related activities. Recovery rates are a key outcome of nutritional programs and reflect the success of treatment protocols and health system responses in managing acute malnutrition among young children. |
|---|---|
| ToC pathway | This indicator directly refers to the Tdh Theory of Change (ToC) as it aims to contribute to 3the three inter-related pathways of change, namely 1) local health system, 2) communities, and 3) mothers, children, and their families. |
| Related services | It is used depending on the service provided by Tdh. |
Definition
This indicator is the proportion of children under 5 years old who were diagnosed with GAM (SAM + MAM) and who have achieved recovery without complications.
Recovery is defined as:
For SAM: Weight-for-height Z-score (WHZ) > -2 SD and/or mid-upper arm circumference (MUAC) ≥ 12.5 cm, with no medical complications.
For MAM: Weight-for-height Z-score (WHZ) ≥ -2 SD and < -1 SD, with no medical complications.
Discharge criteria and recovery may vary from country. In general, are considered discharged individuals who is free from medical complications. In addition, they should have regained their appetite and have achieved and maintained appropriate weight gain without nutrition-related oedema (for example, for two consecutive weighings). Breastfeeding is especially important for infants under six months, as well as for children aged 6 to 24 months. Adherence to discharge criteria to avoid the risks associated with premature discharge must be uphold as it might be a risk of double-counting children re-entering the program.
Complications include severe illness or conditions that require hospitalization or additional medical treatment linked to the malnutrition (i.e., exclude elective surgery).
How to collect & analyse the data
| What do we count? | Children with GAM/SAM who have recovered |
|---|---|
| How to calculate the indicator's value | Numerator: The number of children under 5 years old with GAM who have achieved recovery without complications in a specified period and at Tdh supported health facilities. Denominator: The total number of children under 5 years old with GAM discharged (recovered, deceased, lost to follow-up/discontinued and non-responding to treatment) in the same period and area. Formula: Percentage of children with GAM who have recovered = (Number of recovered children) / (total number of children with GAM) ×100 Note: The international standard for recovery cases is > 75% |
| Data sources | Routine facility data sources: Facility-based data on patient outcomes from nutrition treatment programs, where available. Digital health platform records: Data from digital health platform that track the number of children with GAM who recovered and the total number of children with GAM. Community/population: Cross-sectional nutrition surveys that track recovery rates of children with GAM (i.e., community survey) or cohort studies assessing recovery rates in the target population. |
| Data collection methods and tools | Secondary data review : Monthly, quarterly, and annual reporting from health facilities and DHIS. Community Survey : Baseline, mid-term and endline studies |
| Disaggregation | Data should be stratified by age (i.e., infant under-6months, children under-5 years old), severity of Malnutrition (SAM, MAM), geographic location (i.e., origin of the patient and/or place of screening/diagnosis), type of treatment (i.e., outpatient therapeutic program, supplementary, inpatient care), where appropriate depending on the data source. |
| Important considerations | Note: The denominator to be considered may be adjusted according to the project context. It should then be calculated using the total number of children diagnosed with GAM (SAM and/or MAM), including those discharged, deceased, and lost to follow up. |
Limitations and precautions
It might be difficult to compare this indicator in-between countries as it exists a number of various definitions and measurements methods of GAM and recovery which can affect the data and therefore their comparability.
More so, the case definition (SAM and MAM) requires reliable measurement while it largely depends on the operator. It is important to consider the level of performance expected from the various health personnel or trained CHW to accurately diagnose GAM and offer appropriate treatment and follow-up (i.e., counter-referral data).
The management of complications largely depends on the availability and quality of treatment administered. It goes without saying that other health systems components may affect recovery rates and the analysis of this indicator.
A comprehensive context analysis must be assessed to identify potential bias or other variable interfering with the outcome (i.e., overall food security situation within the catchment population, food market study, blanket supplementary feeding programme, presence of other vertical project such as HIV and TB).
It is also important to consider other aspects of a nutritional program, such as a functional referral system, access to curative care for under-5 years old, Expanded Program on Immunization (EPI), cash and vouchers. The level of Community Engagement and Involvement (CEI) is often a key factor influencing the functionality of such a referral system and should be integrated in the narrative analysis of this indicator.
What further analysis are we interested in?
Per this indicator, we can assess the percentage of children with GAM who have recovered, evaluating the effectiveness of nutritional interventions.
Considering the analysis of disaggregated data, it can inform how different types of interventions impact the recovery rates; among different age for instance (demographic analysis). Gender could also be a factor to be investigated as it may influence access to treatment and therefore potential recovery.
Cross-cutting GIS data and recovery rate per health facility helps examine health outcomes per regions or district, identify disparities and target further interventions.
Additional guidance
Under the technical assistance of HQ, Tdh M&E and operational teams in each delegation should work closely with health authorities, Nutrition working and coordination group, if relevant in the context, and DHIS providers to collect and interpret the data.
If the project only measures SAM or MAM, add a special comment on the reason of the selected measurement (i.e., scope of project) and replace GAM by SAM or MAM in the calculation and the indicator definition. The indicator might be adjusted according to the specificality of the project. The data collected in these kinds of settings cannot be comparable to other contexts who have full GAM data in case aggregation and comparison will be done at regional or global level.
Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum
Standards in Humanitarian Response, fourth edition, Geneva, Switzerland, 2018. Available at: www.spherestandards.org/handbook (Accessed 16 September 2024)
Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children. Geneva: World Health Organization; 2013. PMID: 24649519. Available at: https://pubmed.ncbi.nlm.nih.gov/24649519/ (Accessed 16 September 2024)
Child Malnutrition, UNICEF, 2024. Available at : https://data.unicef.org/topic/nutrition/malnutrition/ (Accessed 16 September 2024)