Global Acute Malnutrition

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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. [1]

Contents

Definition

Countries showing percentage of population suffering from undernourishment, 2006 Percentage population undernourished world map.PNG
Countries showing percentage of population suffering from undernourishment, 2006

To evaluate levels of GAM, workers in an emergency 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. [1] 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%. [2]

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. [1] Weight for height is chosen rather than weight for age since the latter may indicate long-term stunting rather than acute malnutrition. [3]

The World Health Organization also defines other measures of malnutrition including mid-upper arm circumference (MUAC), marasmus and kwashiorkor. [2] 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 six 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. [3]

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. [1] 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. [4]

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, this objective was not met in 7% of targeted sites. GAM rates exceeded 10% in eleven camps in Chad, seven camps in Ethiopia, and one camp in the Central African Republic. [5] 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. [6]

Related Research Articles

<span class="mw-page-title-main">Kwashiorkor</span> Severe protein malnutrition

Kwashiorkor is a form of severe protein malnutrition characterized by edema and an enlarged liver with fatty infiltrates. It is thought to be caused by sufficient calorie intake, but with insufficient protein consumption, which distinguishes it from marasmus. Recent studies have found that a lack of antioxidant micronutrients such as β-carotene, lycopene, other carotenoids, and vitamin C as well as the presence of aflatoxins may play a role in the development of the disease. However, the exact cause of kwashiorkor is still unknown. Inadequate food supply is correlated with occurrences of kwashiorkor; occurrences in high income countries are rare. It occurs amongst weaning children to ages of about five years old.

<span class="mw-page-title-main">Malnutrition</span> Medical condition

Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues and form. Malnutrition is not receiving the correct amount of nutrition. Malnutrition is increasing in children under the age of five due to providers who cannot afford or do not have access to adequate nutrition.

<span class="mw-page-title-main">Internally displaced person</span> Person forced to leave their home who remains within their country

An internally displaced person (IDP) is someone who is forced to leave their home but who remains within their country's borders. They are often referred to as refugees, although they do not fall within the legal definitions of a refugee.

<span class="mw-page-title-main">Refugee camp</span> Temporary settlement for refugees

A refugee camp is a temporary settlement built to receive refugees and people in refugee-like situations. Refugee camps usually accommodate displaced people who have fled their home country, but camps are also made for internally displaced people. Usually, refugees seek asylum after they have escaped war in their home countries, but some camps also house environmental and economic migrants. California is an example of a modern-day camp. Camps with over a hundred thousand people are common, but as of 2012, the average-sized camp housed around 11,400. They are usually built and run by a government, the United Nations, international organizations, or non-governmental organization. Unofficial refugee camps, such as Idomeni in Greece or the Calais jungle in France, are where refugees are largely left without the support of governments or international organizations.

<span class="mw-page-title-main">Marasmus</span> Medical condition

Marasmus is a form of severe malnutrition characterized by energy deficiency. It can occur in anyone with severe malnutrition but usually occurs in children. Body weight is reduced to less than 62% of the normal (expected) body weight for the age. Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. It can be distinguished from kwashiorkor in that kwashiorkor is protein deficiency with adequate energy intake whereas marasmus is inadequate energy intake in all forms, including protein. This clear-cut separation of marasmus and kwashiorkor is however not always clinically evident as kwashiorkor is often seen in a context of insufficient caloric intake, and mixed clinical pictures, called marasmic kwashiorkor, are possible. Protein wasting in kwashiorkor generally leads to edema and ascites, while muscular wasting and loss of subcutaneous fat are the main clinical signs of marasmus, which makes the ribs and joints protrude.

<span class="mw-page-title-main">Kakuma</span> Town in Kenya

Kakuma is a town in northwestern Turkana County, Kenya. It is the site of a UNHCR refugee camp, established in 1992. The population of Kakuma town was 60,000 in 2014, having grown from around 8,000 in 1990. In 1991, the camp was established to host unaccompanied minors who had fled the war in Sudan and from camps in Ethiopia. It was estimated that there were 12,000 "lost boys and girls" who had fled here via Egypt in 1990/91.

<span class="mw-page-title-main">Health in Uganda</span>

Health in Uganda refers to the health of the population of Uganda. The average life expectancy at birth of Uganda has increased from 59.9 years in 2013 to 63.4 years in 2019. This is lower than in any other country in the East African Community except Burundi. As of 2017, females had a life expectancy higher than their male counterparts of 69.2 versus 62.3. It is projected that by 2100, males in Uganda will have an expectancy of 74.5 and females 83.3. Uganda's population has steadily increased from 36.56 million in 2016 to an estimate of 42.46 in 2021. The fertility rate of Ugandan women slightly increased from an average of 6.89 babies per woman in the 1950s to about 7.12 in the 1970s before declining to an estimate 5.32 babies in 2019. This figure is higher than most world regions including South East Asia, Middle East and North Africa, Europe and Central Asia and America. The under-5-mortality-rate for Uganda has decreased from 191 deaths per 1000 live births in 1970 to 45.8 deaths per 1000 live births in 2019.

Famine scales are the ways in which degrees of food security are measured, from situations in which an entire population has adequate food to full-scale famine. The word "famine" has highly emotive and political connotations and there has been extensive discussion among international relief agencies offering food aid as to its exact definition. For example, in 1998, although a full-scale famine had developed in southern Sudan, a disproportionate amount of donor food resources went to the Kosovo War. This ambiguity about whether or not a famine is occurring, and the lack of commonly agreed upon criteria by which to differentiate food insecurity has prompted renewed interest in offering precise definitions. As different levels of food insecurity demand different types of response, there have been various methods of famine measurement proposed to help agencies determine the appropriate response.

<span class="mw-page-title-main">Health in India</span> Overview of health in India

India's population in 2021 as per World Bank is 1.39 billion. Being the world's second-most-populous country and one of its fastest-growing economies, India experiences both challenges and opportunities in context of public health. India is a hub for pharmaceutical and biotechnology industries; world-class scientists, clinical trials and hospitals yet country faces daunting public health challenges like child undernutrition, high rates of neonatal and maternal mortality, growth in noncommunicable diseases, high rates of road traffic accidents and other health related issues.

The anthropometry of the upper arm is a set of measurements of the shape of the upper arms.

<span class="mw-page-title-main">Stunted growth</span> Reduced growth rate in human development

Stunted growth, also known as stunting or linear growth failure, is defined as impaired growth and development manifested by low height-for-age. It is a primary manifestation of malnutrition and recurrent infections, such as diarrhea and helminthiasis, in early childhood and even before birth, due to malnutrition during fetal development brought on by a malnourished mother. The definition of stunting according to the World Health Organization (WHO) is for the "height-for-age" value to be less than two standard deviations of the median of WHO Child Growth Standards. Stunted growth is usually associated with poverty, unsanitary environmental conditions, maternal undernutrition, frequent illness, and/or inappropriate feeding practice and care during early years of life.

<span class="mw-page-title-main">Sahrawi refugee camps</span> Collection of refugee camps set up in the Tindouf Province, Algeria

The Sahrawi refugee camps in Tindouf, Algeria, are a collection of refugee camps set up in the Tindouf Province, Algeria in 1975–76 for Sahrawi refugees fleeing from Moroccan forces, who advanced through Western Sahara during the Western Sahara War. With most of the original refugees still living in the camps, the situation is among the most protracted in the world.

Healthcare in Laos is provided by both the private and public sector. It is limited in comparison with other countries. Western medical care is available in some locations, but remote areas and ethnic groups are underserved. Public spending on healthcare is low compared with neighbouring countries. Still, progress has been made since Laos joined the World Health Organization in 1950: life expectancy at birth rose to 66 years by 2015; malaria deaths and tuberculosis prevalence have plunged; and the maternal mortality ratio (MMR) has declined by 75 percent.

<span class="mw-page-title-main">Epidemiology of malnutrition</span> Overview of global nutritional deficiencies

There were 795 million undernourished people in the world in 2014, a decrease of 216 million since 1990, despite the fact that the world already produces enough food to feed everyone—7 billion people—and could feed more than that—12 billion people.

<span class="mw-page-title-main">Health in Guinea</span> Health challenges in Guinea

Guinea faces a number of ongoing health challenges.

As of 31 August 2020, Cameroon hosted a total refugee population of approximately 421,700. Of these, 280,500 were from the Central African Republic, driven by war and insecurity. In the Far North Region, Cameroon hosts 114,300 Nigerian refugees, with the population sharing their already scarce resources with the refugees.

<span class="mw-page-title-main">Undernutrition in children</span> Medical condition affecting children

Undernutrition in children, occurs when children do not consume enough calories, protein, or micronutrients to maintain good health. It is common globally and may result in both short and long term irreversible adverse health outcomes. Undernutrition is sometimes used synonymously with malnutrition, however, malnutrition could mean both undernutrition or overnutrition. The World Health Organization (WHO) estimates that malnutrition accounts for 54 percent of child mortality worldwide, which is about 1 million children. Another estimate, also by WHO, states that childhood underweight is the cause for about 35% of all deaths of children under the age of five worldwide.

<span class="mw-page-title-main">Healthcare in Madagascar</span>

Hospitals and small medical centers and posts are found throughout the island of Madagascar, although they are concentrated in urban areas and particularly in Antananarivo. In addition to the high expense of medical care relative to the average Malagasy income, the prevalence of trained medical professionals remains extremely low.

<span class="mw-page-title-main">Nakivale Refugee Settlement</span> Place in Isingiro, Uganda

Nakivale refugee settlement is a settlement located in Isingiro District near the Tanzania border in Southwest Uganda.

<span class="mw-page-title-main">Rohingya refugees in Bangladesh</span> Displaced persons from Myanmar in Bangladesh

Rohingya refugees in Bangladesh mostly refer to Forcibly Displaced Myanmar Nationals (FDMNs) from Myanmar who are living in Bangladesh. The Rohingya people have experienced ethnic and religious persecution in Myanmar for decades. Hundreds of thousands have fled to other countries in Southeast Asia, including Malaysia, Indonesia, and Philippines. The majority have escaped to Bangladesh, where there are two official, registered refugee camps. Recently violence in Myanmar has escalated, so the number of refugees in Bangladesh has increased rapidly. According to the UN Refugee Agency (UNHCR), more than 723,000 Rohingya have fled to Bangladesh since 25 August 2017.

References

  1. 1 2 3 4 "Glossary: Global Acute Malnutrition (GAM)". Complex Emergency Database. Retrieved 2011-08-08.
  2. 1 2 "Acute Malnutrition Summary Sheet" (PDF). Save the Children. Retrieved 2011-08-08.
  3. 1 2 Cameron Lockie (2000). Travel medicine and migrant health. Elsevier Health Sciences. ISBN   0-443-06242-0.
  4. "Ten FAQ for famine in southern Somalia". UNICEF. Archived from the original on 2011-09-26. Retrieved 2011-08-08.
  5. "FY 2005 Performance and Accountability Report". U.S. State Department. November 2005. Retrieved 2011-08-08.
  6. Mary Corbett, Allison Oman (January 2006). "Acute Malnutrition in Protracted Refugee Situations: A Global Strategy" (PDF). UNHCR/WFP. Retrieved 2011-08-08.