Global Acute Malnutrition

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]

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]

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.^[4] In 2011, the conditions in some parts of the Horn of Africa met all three criteria.^[5]

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.^[6] 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.^[7]

• "WEST AFRICA - Global Acute Malnutrition (GAM) Prevalence" (PDF). ReliefWeb. 28 May 2009. Archived (PDF) from the original on 2012-09-26. Retrieved 2011-08-08.
• "Global Acute Malnutrition Prevalence (Z-score NCHS reference) – DRC" (PDF). ReliefWeb. April 2011. Archived (PDF) from the original on 2012-09-26. Retrieved 2011-08-08.
• "Complex Emergency Database (CE-DAT) - the international repository of health indicators, including GAM, from crisis settings". CRED. September 2012. Archived from the original on 2020-08-15. Retrieved 2012-09-14.