NUTRITION & MORTALITY INDICATORS IN THE CADRE HARMONISÉ. Olutayo Adeyemi

Transcription

1 NUTRITION & MORTALITY INDICATORS IN THE CADRE HARMONISÉ Olutayo Adeyemi

2 OUTLINE Brief Introduction Measurement of nutrition basics Mortality basics Nutrition and mortality indicators in Cadre Harmonisé

3 INTRODUCTION The Cadre Harmonisé analytical framework relies on the conceptual frameworks for: Food security Nutrition Sustainable livelihoods Danger, hazards and vulnerability

4 NUTRITION FRAMEWORK

5 NUTRITION BASICS: FORMS OF MALNUTRITION Malnutrition Overnutrition Overweight & obesity (High body mass index) Anthropometric deficits Undernutrition Stunting (Low height-for-age) Wasting (Low weight-for-height) Underweight (Low weight-for-age or low body mass index) Micronutrient deficiencies Indicative of CHRONIC UNDERNUTRITION Indicative of ACUTE MALNUTRITION Composite indicator NOT mutually exclusive

6 UNDERNUTRITION BASICS Acute malnutrition Short term or sudden onset undernutrition, characterized by weight loss (wasting) and/or or bilateral oedema Results from significant restrictions in dietary intake and/or presence of infections Reduces resistance to disease and impairs a range of bodily functions In the early stages can be reversed through adequate food and health care Can be moderate or severe Both moderate and severe acute malnutrition are associated with an increased risk of mortality

7 ACUTE MALNUTRITION

8 UNDERNUTRITION BASICS Chronic malnutrition (stunting) Slow, cumulative process that develops over the long-term as a result of inadequate dietary intake or repeated infections, or both Does not necessarily mean that current dietary intake or health is inadequate the growth failure may have occurred at some time in the past May be irreversible by two years of age Strongly associated with poverty, poor health, impaired physical and mental development and performance

9 CHRONIC MALNUTRITION

10 MEASURING MALNUTRITION OUTCOMES: ANTHROPOMETRY Most common method of measuring nutritional status Includes measurement of: Weight Height Mid Upper Arm Circumference Measurements are compared with reference standards to provide information about nutritional status Reference standards are values that reflect the normal range for a particular parameter in a healthy population Reference standards are often age-specific, thus anthropometric measurements often require accurate knowledge of age

11 MEASURING MALNUTRITION OUTCOMES: ANTHROPOMETRY 1. Measuring weight 2. Measuring Height and length 3. MUAC measurement

12 MEASURING MALNUTRITION OUTCOMES: ANTHROPOMETRY Uses standardized methods Requires skill and practice for precision and accuracy Measurement of age also requires skill and practice

13 USING ANTHROPOMETRIC MEASUREMENTS Acute malnutrition (wasting) Weight-for-height/length z-scores MUAC measurements compared to standard thresholds Oedema** Chronic malnutrition (stunting) Height/length-for-age z-scores Malnutrition in adults Body Mass Index (BMI)

14 WEIGHT-FOR-HEIGHT Z-SCORE WHZ measures wasting of the entire body WHZ compares the weight and height of each child to weight and height standards published by the WHO in 2006 The standards are age and sex specific WHZ scores are calculated for each child based on the comparison It is calculated by z = x μ σ where x is each child s measurement, μ is the population average, and σ is the standard deviation

15 MID UPPER ARM CIRCUMFERENCE MUAC measures wasting of the mid upper arm The MUAC is compared to standard reference cut-offs The cut-offs are not age or sex specific

16 OEDEMA Not an anthropometric measurement A clinical assessment of signs Indicator of acute malnutrition Used with anthropometric measurements to diagnose acute malnutrition

17 CLASSIFICATION OF ACUTE MALNUTRITION (USED ONLY IN CHILDREN 6 TO 59 MONTHS OLD) Global Acute Malnutrition (GAM) Indices Weight-for-height z-score (WHZ) MUAC Oedema Moderate Acute Malnutrition (MAM WHZ between 2 and 3 SD MUAC between 11.5 cm and 12.5 cm Severe Acute Malnutrition (SAM) Less than 3 SD Less than 11.5 cm Bilateral

18 WEIGHT-FOR-HEIGHT Z-SCORE

19 MUAC Red <11.5 cm Severe Acute Malnutrition Yellow 11.5 to 12.4 cm Acute Moderate Malnutrition Green >12.5 cm Normal

20 BODY MASS INDEX (BMI) Suitable for assessing the nutritional status of adults, except pregnancy and lactating women Calculated by Weight (kg) Height m Height (m) Cut-offs Underweight = BMI <18.5 kg/m 2 Normal weight = BMI between 18.5 kg/m 2 and 24.9kg/m 2 Overweight = BMI between 25.0kg/m 2 and 29.9 kg/m 2 Obese = BMI 30.0 kg/m 2

21 EXERCISE Use the WHO reference table given to classify the following children as having moderate acute malnutrition, severe acute malnutrition or no malnutrition A girl aged 6 months with height of 61 cm and weight of 4.8kg A girl aged 10 months with height of 68.5 cm and weight of 7 kg A girl of 15 months with height of 74.5 cm and weight of 6.9 kg

22 MORTALITY BASICS Mortality means death, and it describes death or death related issues Because death results from so many health problems, it can provide an overall indicators of the general health status of a population It can also provide information on nutritional status because widespread malnutrition among children or adults almost always results in an elevation of the mortality rate, especially if the level of communicable diseases is also high

23 MEASURING MORTALITY Example: If you hear that there have been 139 deaths in a certain population, what exactly does this mean.? What does this tell you about the death rate? Calculating the mortality rate is more than just counting or recording deaths. Four parameters are taken into account: The time period during which the deaths occurred; The number of deaths (the numerator of the mortality rate); The size of the population at risk from which the deaths came (the denominator of the mortality rate); A constant: the result of the fraction is multiplied with factor of 10 so as the rate can be expressed as whole number(1000, etc.)

24 KEY MORTALITY INDICATORS Crude Death Rate (CDR) The mortality rate for all causes in a population Reported as number of deaths per 10,000 people per day Most commonly measured in surveys conducted in emergency settings (e.g. SMART surveys) Under-five Death Rate (U5DR) Rate of mortality in the population of children under five years of age Reported as number of deaths among children under 5 per 10,000 children under 5 per day Under-five mortality rate (U5MR) Probability per 1,000 that a newborn will die before 5 years of age Commonly measured in censuses, DHS surveys etc.

25 CALCULATION OF CRUDE DEATH RATE CDR = Number of deaths Total population a 10,000 Time interval = Deaths/10,000 people/day a Population present at the midpoint of the time interval Time interval: length of time (in days) which respondents are asked to state if any deaths have occurred (i.e. the recall period )

26 EXAMPLE Survey team implemented the survey in 1000 households The sum of the total population across all 1000 households was 4890 people 51 deaths were recorded Recall period was from February 1, 2013 April 5, 2013 (64 days) CDR = , CDR = 51/ CDR = 1.63/10,000/day

27 CALCULATION OF UNDER 5 DEATH RATE U5DR = Number of deaths of children 0 5 years old Population of children 0 5 years old 10,000 Time interval

28 NUTRITION AND MORTALITY IN CADRE HARMONISÉ Nutritional status and mortality are two of four outcome indicators in the Cadre Harmonisé (CH) Like the other outcomes, the indicators used to analyze the nutritional status and mortality situation are categorized into two: Direct evidence: Measures directly and accurately the status of the outcome indicators Indirect evidence: Does not measure the outcome indicators directly but provides indicative evidence that can be used to infer the outcomes

29 NUTRITION OUTCOME INDICATORS Direct Evidence: Global Acute Malnutrition (GAM) using WHZ in children 6 to 59 months old Body Mass Index for the population Indirect evidence: Mid Upper Arm Circumference (MUAC) in children 6 to 59 months old

30 NUTRITION OUTCOME INDICATORS CLASSIFICATION SCALE USED FOR PHASING

31 MORTALITY OUTCOME INDICATORS Direct Evidence: Crude Death Rate Under Five Death Rate Indirect evidence: Infant Mortality Rate: The mortality rate for children under 1 year of age Neonatal Mortality Rate: The mortality rate for children under 1 month of age Case Fatality Rate (malaria, measles, diarrhoea, acute respiratory infections): Proportion of reported cases of a specified disease or condition that die within a specified time Under Five Death Probability Severe Acute Malnutrition BMI in adults

32 MORTALITY CLASSIFICATION SCALE USED FOR PHASING

33 SOURCES OF NUTRITION AND MORTALITY DATA SMART Surveys Other representative surveys GAM data from sentinel sites GAM data from recent screening

34 CURRENT ANALYSIS MARCH (MARCH APRIL MAY) Is there any recent representative survey (January-February-March) GAM (WHZ) or MUAC data coming from sentinel sites or recent screening (January- February-March). Use the GAM and/or BMI values as direct evidence or MUAC as indirect evidence for the phasing of the nutrition outcome indicator Use the GAM values (WHZ) or GAM (MUAC) for the phasing of the result nutrition outcome indicator Times series (historical data) of the GAM indicator coming form nutrition surveys conducted in lean season (April-September). Use the median of the GAM of the times series (historical data) for the phasing of the nutrition outcome indicator We cannot use nutrition indicator

35 PROJECTED SITUATION ANALYSIS (JUNE-JULY-AUGUST) Times series (historical data) of GAM coming from survey conducted in the period of (April- September)? NO Yes Use the median of the GAM of the times series (historical data) for the phasing of the nutrition outcome indicator We cannot use nutrition indicator