« IS IT SERIOUS DOCTOR ? »

Measuring, monitoring & assessing malnutrition in individuals & a community

...

Anthropometry ?

Non-invasive technique for measuring specific features of the human body

« Anthropometry provides the single most portable, universally applicable, inexpensive and non-invasive technique for assessing the size, proportions and composition of the human body. It reflects both health and nutritional status and predicts performance, health and survival. » (World Health Organisation)

Children under 5 years old•Growth indicators•Height•Weight•MUAC•Other indicators : head circumference, skin pinch ...

Age-sensitive

Measuring individuals

Adults•Height•Weight•MUAC•Skin pinch

Independent of age

Anthropometric measurements

MUAC ?Mid-Upper Arm Circumference

More on this later ...

Main anthropometric indicatorsChildren under 5Weight to Height inadequate = Acute malnutrition -Wasting

Height to age inadequate = Chronic malnutrition – Stunting

Weight to age inadequate = UnderweightBilateral oedema (2 legs or 2 feet) = Severe Acute MalnutritionChildren & AdultsMUAC = Acute malnutritionAdultBody Mass Index (BMI) > Malnutrition & obesity (except pregnant women)

Age Height Weight

To measure a person's nutritional state, you need to know:

The MUAC tape

Measure the left arm midway between the tip of the elbow & the tip of the shoulder-blade. The arm must be relaxed.

The Mid-Upper Arm Circumference (MUAC) is an indicator of body mass.

SimpleQuickCheap

Screening

For a child, you need to know:

Presence of oedema

Sex Boy or girl

Clinical examination

A nurse or doctor looks for oedema on the feet, calves or face

A child with oedema is always deemed to have Severe Acute Malnutrition

orSAM

Body Mass Index (BMI)

BMI measures body fat. It is used to detect whether adolescents, adults or old people are underweight or suffering from malnutrition but also whether they are overweight or obese.

Adults (except pregnant women) :

Calculating your BMI

weight(kg)[height(m) x height(m)]

BMI <18.5: underweightBMI 18.5 – 24.9: normalBMI >25: overweightBMI >30: obesity

QUICK QUIZ- What does an anthropometric indicator

measure?

- Name 3 things you have to know about a person.

- What does BMI mean? What does it measure?

- What does MUAC mean? What does it measure?

Non-anthropometric indicatorsMICRONUTRIENT DEFICIENCY- Clinical examination- Biochemical tests

FOOD CONSUMPTION- Survey of food consumption patterns- Food diversity score

Jargon Buster: MORTALITY• Crude Death Rate (CDR)• Under-5 Death Rate (U5DR) Under-5 Mortality Rate (U5MR)

Maternal Mortality Ratio (MMR) Mainly in crisis or emergency feeding stations

Number of deaths for given population per day

e.g. : 1,06 / 10 000 people / day

Jargon Buster: MORBIDITY

Number of people with a given illness during a given time period in a given population

Diarrhoea, Cholera, Respiratory disease ...

Is it serious, Doctor ?To know whether an individual has a nutritional problem or to know the PREVALENCE of malnutrition for a group of individuals (population), compare the indices with benchmarks. This enables us to calculate significant numbers or indicators.

Anthropometry => needs reference

points

Measure the divergence from «normality»

International REFERENCE CHARTS:

- OLD (National Centres for Health Statistics/WHO – 1978)- NEW (WHO/Multicentre Gowth Reference Study - 2006)

To find the ANSWERS …

Consult the NORMS …

INDIVIDUALS

Children

« What if I'm a pygmy ? »

« It's not the same if I'm a Dogon, a European or an American ! Or is it ? »

WHO growth norms describe normal growth in infancy.

Everywhere in the world, between the ages of 0 and 5, children grow in the same way …

WHO norms can be used to evaluate children anywhere in the world, whatever their ethnic group, their socio-economic situation or the type of food they eat because ...

Classifying Acute Malnutrition or “Wasting”

Acute Malnutrition (Weight/Height

index)Percentage Z-score Bilateral Oedema

Severe (SAM) <70% <-3 z-score Yes/No

Severe (SAM) >70% >-3 z-score Yes

Moderate (MAM) <80% à ≥ 70%

<-2 z-score à ≥ -3 z-score No

Global (GAM) <80% <-2 z-score Yes/No

Mid-Upper Arm Circumference

Red < 115 mm

SevereMalnutrition

Orange 115 to 124

mmModerate

Malnutrition

Yellow 125 to 134

mmRISK of

Malnutrition

Green > 135 mm

Normal

MUAC

Body Mass Index (BMI)

Adults (except pregnant women)

weight(kg) / [height(m) * height(m)]

BMI can be used with children, but the thresholds are different.

GROUPS OF INDIVIDUALS

« Does this country face a nutritional crisis ? »

« Is the nutritional situation in this region worrying ?»

« Is there a risk of ... famine ? »

GAM?

Global Acute Malnutrition Proportion or % of people with acute

malnutrition in a given populationExperts refer to “prevalence” of acute

malnutritionChildren six to 59 months assessed

Gathering the informationSurveys (general population)

National (ou regional)oOccasional (variable timeframes)oPermanent (existing systems)

Targeted (zones at risk)Focus sites (selected population)

CentralisedCommunal

Health system (self-selected population)Registration/identification of malnutrition casesGrowth monitoring & promotion statistics

Prevalence of Malnutrition

Proportion (%) of a given population UNDER a given threshold

• Reference population (Bell-shaped Gaussian curve) defines what is normal

• Chart a curve with measurements from individuals you survey

• COMPARE

Early-warning signs … Alarm bells ...

The ThresholdsPrevalence level

Description of the situation

Chronic Malnutrition

Global Acute Malnutrition

Underweight

Low Good < 20 % < 5% < 10%

Moderate Monitor 20 to 29 % 5 to 9 % 10 to 19%High Alert

intervention required30 to 39% 10 to 14 % 20 to 29%

Very high

40% and + 15 % and + 30% and +

Other indicators Alert EmergencyUnder-5 Death Rate (U5DR)

2/10,000/day

4/10,000/day

Crude Death Rate (CDR)1/10,000/day

2/10,000/day

Emergency

Humanitarian crisis

Source: DHS/MICS/SMART Surveys

Benin4.7%<-2SD WHZDec 2008

Burkina Faso10.8% GAM

Aug/Sept 2011

CAR7.4%<-2SD WHZMICS 2010

Ivory Coast5.4% GAMJune/July 2011

Cameroon5.6%<-2SD WHZDHS-MICS 2011

DRC9.0%<-2SD WHZMICS 2010

Congo7.0%<-2SD WHZEDS 2005

Cape Verde

Gabon2.7%<-2SD WHZEDS 2000

Ghana8.5%<-2SD WHZDHS 2008

Guinea8.3%<-2SD WHZMICS 2008

Gambia6.4%<-2SD WHZMICS 2006

Guinea-Bissau5.8% <-2SD WHZMICS 2010

Liberia2.8% GAMJune 2010

Mali 10.9% GAMJune/July 2011

Mauritania6.8 % GAM Dec 2011

Niger 12.3% GAM May/June 2011

Nigeria11.0%<-2SD WHZDHS 2008

Senegal10.1%<-2SD WHZDHS 2010-2011

Sierra Leone7.6% GAMJune/Aug 2010

Sao Tome and Principe10.5%<-2SD WHZDHS 2008-2009

Chad16.3%<-2SD WHZMICS 2010

Togo4.5% GAMDec 2010

GAM > 15%

GAM 10 - 14.9%

GAM 5 - 9.9%

GAM 0 - 5%

Global Acute MalnutritionWest & Central Africa

UPDATED February, 2012

Source: DHS/MICS/SMART Surveys

Benin37%Dec 2008

Burkina Faso34.1%

Aug/Sept 2011

CAR40.7%MICS 2010

Ivory Coast27.3% June/July 2011 Cameroon

32.5%DHS-MICS 2011

DRC43%MICS 2010

Congo26%EDS 2005

Cape Verde

Gabon20.6%EDS 2000

Ghana28%DHS 2008

Guinea36.2%MICS 2008

Gambia22.4%MICS 2006

Guinea-Bissau32.2%MICS 2010

Liberia41.8%Jun/Aug 2010

Mali 27.1% June/July 2011

Mauritania25.5% Dec 2011 Niger

51.0% May/June 2011

Nigeria38.3%DHS 2008

Senegal26.5%DHS 2010-2011

Sierra Leone34.8%Jul/Aug 2010

Sao Tome and Principe29.3%DHS 2008-2009

Chad38.7%MICS 2010

Togo28.4%Dec 2010

Stunting > 40%

Stunting 30 – 39.9%

Stunting 20 – 29.9%

Stunting 0 – 19.9%

Chronic MalnutritionWest & Central Africa

UPDATED February, 2012

IPC: Integrated Food Security Phase Classification developed by UN agencies & NGOs using existing data (mortality rates, GAM, access to food and water, security, etc) to place geographical areas into categories ranging from “Generally food secure” to “Famine”

The « F » word

CDR - Crude death rate: Deaths per 10,000 people per day in a given area over a specified period.

A loaded word

To be accurate, you need to understand the jargon:

GAM: Global Acute Malnutrition – Proportion or % of cases for a given population

Famine is declared when GAM (Global Acute Malnutrition) exceeds 30 % ... CDR (Crude death rate) exceeds two ... at least 20 % of a population receives less than 2,100 calories per day. Source: IRIN

FamineIPC definition of Famine/Humanitarian catastrophe : « Extreme social upheaval with complete lack of food access and/or other basic needs where mass starvation, death, and displacement are evident. »

Strong words Used accurately the « F » word

can be a wake-up call!

Thank You