I am wondering if anyone is using or has come across any guidelines (perhaps in draft form) for the level of SAM prevalence (in NCHS or new WHO standards) that indicate a nutritional emergency and tirgger a response such as CMAM. The UN uses its 10% GAM threshold, but I haven't found any guidleine that mentions SAM prevalence. I seem to remember the FSAU had SAM as one of its criteria in an earlier version of its classification tool for food security emergencies, but I haven't been able to find it since, and only GAM is included in the more global Integrated Food Security Phase Classification (IPC) assessment tool. I realise a context analysis to establish the relative burden of different diseases and acute malnutrition is the gold standard in each situation, but I'm wonderingt if there has been any agreement on what level of SAM prevalence should almost definitely trigger an immediate reponse, and then, even beyond emergencies, what level of SAM might indicate that it is a significant public health burden and justify advocacy for the inclusion of CMAM in the government's essential health package. I realise that in my head I have been using very roughly above 1% as a general benchmark for SAM being a significant burden (based on NCHS WHZ <-3 and or oedema) and above 2% venturing into slightly alarming, above 3% being an emergency, but that is really not based on anything substantial. It is also hard to justify these benchmarks given the lack of precision on SAM estimates from clustered nutrition surveys (it's a bit easier if there is a series of surveys to get the general sense over time or to single out a seasonal peak). I wanted to hear if I have missed any major guidelines and/or what other people are using. It seems more and more agencies and governments are considering implementing CMAM without the supplementary feeding component, yet we are sort of basing our decisions on a classification tool hinging on GAM levels. Any thoughts would be greatly appreciated. Thanks,
Kate
|