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]


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]


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]


  1. 1.0 1.1 1.2 1.3 "Glossary: Global Acute Malnutrition (GAM)". Complex Emergency Database. Archived from the original on 2018-10-02. Retrieved 2011-08-08.
  2. 2.0 2.1 "Acute Malnutrition Summary Sheet" (PDF). Save the Children. Archived (PDF) from the original on 2011-09-27. Retrieved 2011-08-08.
  3. 3.0 3.1 Cameron Lockie (2000). Travel medicine and migrant health. Elsevier Health Sciences. ISBN 0-443-06242-0.{{cite book}}: CS1 maint: url-status (link)
  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. Archived from the original on 2019-09-28. Retrieved 2011-08-08.
  6. Mary Corbett, Allison Oman (January 2006). "Acute Malnutrition in Protracted Refugee Situations: A Global Strategy" (PDF). UNHCR/WFP. Archived (PDF) from the original on 2012-10-19. Retrieved 2011-08-08.

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