Global Acute Malnutrition
Encyclopedia
Global Acute Malnutrition (GAM) is a measurement of the nutritional status of a population that is often used in protracted refugee situations.
Along with the Crude Mortality Rate, it is one of the basic indicators for assessing the severity of a humanitarian crisis.
To evaluate levels of GAM, Workers in an emergency situation measure the weight and height of children between 6 and 59 months.
They then use the results as a proxy for the health of the population as a whole.
The weight to height index is compared to the same index for a reference population that has no shortage of nutrition.
All children with weight less than 80% of the median weight of children with the same height in the reference population, and/or suffering from Oedema, are classified as GAM.
The World Health Organization
describes Moderate Acute Malnutrition (MAM) as GAM in the 79% - 70% range, and Severe Acute Malnutrition (SAM) as GAM below 70%.
An alternative definition is that a child suffers from GAM if their weight to height ratio is less than the value at -2 Standard Deviations on the Z-Score for the same measurement in the reference population.
SAM is defined as a weight to height ratio less than -3 Standard Deviations on the Z-score for the reference population.
In practice, since the distribution of weight to height ratios is much the same in all populations, the two definitions are equivalent.
Weight for height is chosen rather than weight for age since the latter may indicate long-term stunting
rather than acute malnutrition
.
The World Health Organization also defines other measures of malnutrition including the Mid-upper arm circumference, Marasmus
and Kwashiorkor
.
Mid-upper arm circumference (MUAC) measurement, if conducted by well-trained staff, can give a quick assessment of new arrivals at a camp. It is based on the observation that this measurement does not change much in children between 6 months and five years old, so comparison to a "normal" measurement is useful. Based on analysis of field results, MUAC < 125mm corresponds to GAM and MUAC < 110mm with or without Oedema corresponds to SAM.
According to the Integrated Food Security Phase Classification
(IPC), a famine is declared if three conditions exist. First, at least 20% of households face extreme food shortages with limited ability to cope. Second, GAM prevalence exceeds 30%. Third, crude death rates exceed two persons per 10,000 per day. In 2011 the conditions in some parts of the Horn of Africa
met all three criteria.
In 2005 in 7% of targeted sites this objective was not met.
GAM rates exceeded 10% in eleven camps in Chad
, seven camps in Ethiopia
, and one camp in the Central African Republic
.
A study by the UNHCR published in January 2006 found unacceptable GAM levels in UNHCR/WFP supported protracted refugee situations including Chad (up to 18%), Eritrea
(18.9%), Ethiopia (up to 19.6%), Kenya
(up to 20.6%), Sierra Leone
(16%) and South Sudan
(16%). The report questioned why GAM rates were so high despite all efforts to bring them down, and why camps in Africa had rates consistently over 15% while camps in Asia were usually below 12% GAM.
Along with the Crude Mortality Rate, it is one of the basic indicators for assessing the severity of a humanitarian crisis.
Definition
They then use the results as a proxy for the health of the population as a whole.
The weight to height index is compared to the same index for a reference population that has no shortage of nutrition.
All children with weight less than 80% of the median weight of children with the same height in the reference population, and/or suffering from Oedema, are classified as GAM.
The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
describes Moderate Acute Malnutrition (MAM) as GAM in the 79% - 70% range, and Severe Acute Malnutrition (SAM) as GAM below 70%.
An alternative definition is that a child suffers from GAM if their weight to height ratio is less than the value at -2 Standard Deviations on the Z-Score for the same measurement in the reference population.
SAM is defined as a weight to height ratio less than -3 Standard Deviations on the Z-score for the reference population.
In practice, since the distribution of weight to height ratios is much the same in all populations, the two definitions are equivalent.
Weight for height is chosen rather than weight for age since the latter may indicate long-term stunting
Stunted growth
Stunted growth is a reduced growth rate in human development. It is a primary manifestation of malnutrition in early childhood, including malnutrition during fetal development brought on by the malnourished mother. In developing countries, stunted growth is a common problem affecting a large...
rather than acute malnutrition
Malnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
.
The World Health Organization also defines other measures of malnutrition including the Mid-upper arm circumference, Marasmus
Marasmus
Marasmus is a form of severe protein-energy malnutrition characterized by energy deficiency.A child with marasmus looks emaciated. Body weight may be reduced to less than 80% of the average weight that corresponds to the height . Marasmus occurrence increases prior to age 1, whereas kwashiorkor...
and Kwashiorkor
Kwashiorkor
Kwashiorkor is an acute form of childhood protein-energy malnutrition characterized by edema, irritability, anorexia, ulcerating dermatoses, and an enlarged liver with fatty infiltrates. The presence of edema caused by poor nutrition defines kwashiorkor...
.
Mid-upper arm circumference (MUAC) measurement, if conducted by well-trained staff, can give a quick assessment of new arrivals at a camp. It is based on the observation that this measurement does not change much in children between 6 months and five years old, so comparison to a "normal" measurement is useful. Based on analysis of field results, MUAC < 125mm corresponds to GAM and MUAC < 110mm with or without Oedema corresponds to SAM.
Interpretation
If 10% or more of children are classified as suffering from GAM, there is generally considered to be a serious emergency, and with over 15% the emergency is considered critical.According to the Integrated Food Security Phase Classification
Integrated Food Security Phase Classification
The Integrated Food Security Phase Classification , also known as IPC scale, is a tool for improving food security analysis and decision-making...
(IPC), a famine is declared if three conditions exist. First, at least 20% of households face extreme food shortages with limited ability to cope. Second, GAM prevalence exceeds 30%. Third, crude death rates exceed two persons per 10,000 per day. In 2011 the conditions in some parts of the Horn of Africa
Horn of Africa
The Horn of Africa is a peninsula in East Africa that juts hundreds of kilometers into the Arabian Sea and lies along the southern side of the Gulf of Aden. It is the easternmost projection of the African continent...
met all three criteria.
Objectives and results
The U.S. State Department has set a target that less than 10% of children under five should suffer from Global Acute Malnutrition in complex humanitarian emergencies.In 2005 in 7% of targeted sites this objective was not met.
GAM rates exceeded 10% in eleven camps in Chad
Chad
Chad , officially known as the Republic of Chad, is a landlocked country in Central Africa. It is bordered by Libya to the north, Sudan to the east, the Central African Republic to the south, Cameroon and Nigeria to the southwest, and Niger to the west...
, seven camps in Ethiopia
Ethiopia
Ethiopia , officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa. It is the second-most populous nation in Africa, with over 82 million inhabitants, and the tenth-largest by area, occupying 1,100,000 km2...
, and one camp in the Central African Republic
Central African Republic
The Central African Republic , is a landlocked country in Central Africa. It borders Chad in the north, Sudan in the north east, South Sudan in the east, the Democratic Republic of the Congo and the Republic of the Congo in the south, and Cameroon in the west. The CAR covers a land area of about ,...
.
A study by the UNHCR published in January 2006 found unacceptable GAM levels in UNHCR/WFP supported protracted refugee situations including Chad (up to 18%), Eritrea
Eritrea
Eritrea , officially the State of Eritrea, is a country in the Horn of Africa. Eritrea derives it's name from the Greek word Erethria, meaning 'red land'. The capital is Asmara. It is bordered by Sudan in the west, Ethiopia in the south, and Djibouti in the southeast...
(18.9%), Ethiopia (up to 19.6%), Kenya
Kenya
Kenya , officially known as the Republic of Kenya, is a country in East Africa that lies on the equator, with the Indian Ocean to its south-east...
(up to 20.6%), Sierra Leone
Sierra Leone
Sierra Leone , officially the Republic of Sierra Leone, is a country in West Africa. It is bordered by Guinea to the north and east, Liberia to the southeast, and the Atlantic Ocean to the west and southwest. Sierra Leone covers a total area of and has an estimated population between 5.4 and 6.4...
(16%) and South Sudan
South Sudan
South Sudan , officially the Republic of South Sudan, is a landlocked country located in the Sahel region of northeastern Africa. It is also part of the North Africa UN sub-region. Its current capital is Juba, which is also its largest city; the capital city is planned to be moved to the more...
(16%). The report questioned why GAM rates were so high despite all efforts to bring them down, and why camps in Africa had rates consistently over 15% while camps in Asia were usually below 12% GAM.