Average Weight Gain

Outcome

average weight gain (g/kg/day) among children aged 6–59 months discharged as recovered from treatment for [specify: severe / moderate] acute malnutrition

The indicator measures the average rate of weight gain among children discharged as recovered from a defined acute malnutrition treatment programme. It can help assess treatment response and programme performance when interpreted alongside other treatment outcomes. Weight gain can also be monitored during treatment to assess an individual child's response to care; this is a related monitoring use and should not be confused with the programme-level average described here.

1) For the programme-level indicator, identify children aged 6–59 months discharged as recovered from the defined treatment group during the reporting period. Calculate the indicator for all eligible recovered children where feasible. If this is not feasible, use a simple random sample; the 2015 standardised CMAM reporting guidance suggests a random sample of at least 40 beneficiaries as a pragmatic estimate. Calculate the indicator separately for children treated for severe and moderate acute malnutrition.

   

2) For each child included in the calculation, calculate the weight gain as follows:

• For a child without nutritional oedema at admission, subtract the child’s weight at admission from their weight when discharged as recovered.

• For a child with nutritional oedema at admission, subtract the lowest weight recorded after the oedema had disappeared from their weight when discharged as recovered.

• Multiply the difference by 1,000 to convert the weight gained from kilograms to grams.

• Divide the result by the child’s weight at admission (in kg), or, for a child admitted with oedema, by the lowest weight recorded after the oedema had disappeared (also in kg).

• Divide the result by the number of days between the admission date and discharge date, or, for a child admitted with oedema, between the date of the lowest post-oedema weight and the discharge date.

• The final result is the child’s average weight gain in grams per kilogram per day (g/kg/day).

3) Calculate the average weight gain of all children included by dividing the sum of their individual weight-gain values by the number of children included. Calculate and report average weight gain separately for children admitted with and without nutritional oedema. When reporting the result, specify the treatment population, reporting period and number of children included.

This data can be disaggregated by sex, age group, geographic area and treatment site, and, if relevant and feasible, also by disability status or other context-specific vulnerability characteristics. Average weight gain should be reported separately for children admitted with and without nutritional oedema, as specified in the methodology above.

1) No separate survey is required. Use routine treatment records, ensuring that weights, dates, nutritional oedema status and discharge outcomes are recorded consistently.

     

2) Do not apply a single universal threshold to classify programme-level average weight gain as poor, moderate or good. WHO's 2021 training course on inpatient management of severe acute malnutrition uses <5, 5 to <10 and ≥10 g/kg/day to classify poor, moderate and good weight gain during inpatient rehabilitation; these are not generic thresholds for OTP programme performance. Sphere 2018 recommends calculating mean weight gain separately for people with and without nutritional oedema and does not provide a numerical average-weight-gain performance target. Interpret programme-level average weight gain against the applicable treatment protocol and in relation to the treatment setting and trends over time.

    

3) Because the programme-level indicator is calculated only among children discharged as recovered, it does not describe outcomes for all children admitted to treatment. Interpret it together with recovery, death, default, non-recovery and average length of stay.

Also consider using the following indicators:

• Average Length of Stay (helps interpret weight gain alongside treatment duration)

• Recovery (Cure) Rate (shows the proportion of discharged children who recover)

• Death Rate (captures mortality excluded from average weight gain among recovered children)

• Default Rate (captures treatment discontinuation excluded from this indicator)

• Non-Recovery Rate (captures unsuccessful treatment outcomes excluded from this indicator)