Coverage of Acute Malnutrition Treatment Services

Outcome

% of children aged [specify target age group] with [specify: moderate / severe] acute malnutrition receiving relevant treatment

Treatment coverage measures the proportion of children in a defined target population and geographic area who meet the specified criteria for [moderate / severe] acute malnutrition and are receiving relevant treatment. It indicates the extent to which treatment is reaching children who need it. It does not by itself measure treatment quality or outcomes such as recovery, default or mortality.

Before assessing coverage, define the target age group, geographic area, acute malnutrition category (MAM or SAM), and the criteria used to identify children who should be receiving treatment. Ensure that the definition used to identify cases is compatible with the programme criteria, and clearly document any differences.

Direct treatment coverage can be assessed using SQUEAC (Semi-Quantitative Evaluation of Access and Coverage) or SLEAC (Simplified Lot Quality Assurance Sampling Evaluation of Access and Coverage). SQUEAC combines routine programme data, qualitative investigation and case finding to estimate coverage, understand barriers and boosters, and identify actions to improve access. SLEAC is designed primarily for more rapid classification or estimation of coverage across multiple service-delivery areas. Select the method according to the purpose and geographic scale of the assessment, available resources and team expertise. See detailed guidance below.

Follow the calculation procedures specified by the chosen SQUEAC or SLEAC methodology. When comparing coverage results over time or between areas, ensure that the assessments used comparable target populations, criteria and calculation approaches. Also report the assessment area, dates, target age group and criteria used to identify children needing treatment.

If a direct coverage assessment is not feasible, follow applicable national guidance when using routine screening, referral, admission or other programme data to estimate coverage. Clearly identify such results as indirect estimates and do not present them as methodologically equivalent to a direct SQUEAC/SLEAC assessment.

This data can be disaggregated by sex, age group, geographic area and other relevant groups. Only report disaggregated coverage estimates where the assessment design and number of cases identified allow reliable interpretation.

1) Sphere 2018 uses coverage thresholds of >50% in rural areas, >70% in urban areas and >90% in camps for MAM and SAM treatment services in humanitarian response. These thresholds should not be treated as universal targets outside humanitarian response; use applicable national targets and interpret coverage in context.

  

2) For moderate acute malnutrition (MAM), define the relevant treatment and eligibility criteria according to the applicable national protocol; do not assume that a Supplementary Feeding Programme is the treatment model in every context.

  

3) Programmatic data should be analysed to identify areas of potential high and low coverage. Qualitative data are then collected to look for boosters and barriers to coverage, and gain further understanding of reasons why acutely malnourished children are accessing (or not) treatment.

  

4) The time required depends on the assessment scale, accessibility, travel, staffing and team experience. As an indicative guide, a full SQUEAC takes around 21 days, while SLEAC takes around 5–7 days per district. A follow-up SQUEAC can take around 7–10 days. SQUEAC generally provides a more detailed analysis of barriers and boosters, while SLEAC is designed for more rapid spatial classification or estimation.

  

5) If the team lacks practical experience with SQUEAC or SLEAC, seek support from an experienced coverage-assessment specialist for assessment design, training, supervision and quality assurance.

Also consider using the following indicators:

• Coverage of MUAC Screening (shows whether screening is reaching the target child population, an important upstream determinant of treatment coverage)

• Referrals’ Effectiveness (shows whether children identified and referred through screening actually reach treatment)

• Recovery (Cure) Rate (complements treatment reach with an indicator of treatment outcome)

• Default Rate (helps identify retention problems that can reduce programme effectiveness and may reflect access barriers)