15. Moderate acute malnutrition management mortality rate

15. Moderate acute malnutrition management mortality rate

VERSION

V5.0 - 2026.03 — Existing with revisions

INDICATOR CODE

15

TECHNICAL OWNER

PRG-S Nutrition

INDICATOR TYPE

Country Level Outcome Indicator

INDICATOR CLASSIFICATION

Complementary

INDICATOR SCOPE

Programme specific

APPLICABILITY

The selection of this indicator is recommended against the following sub-activities in CSPs logframes. Selection of the below sub-activities will NOT trigger in COMET the mandatory selection of this indicator:

1. Management of moderate acute malnutrition/undernutrition (MAM)

2. HIV/TB care and treatment (HIV/TB_C&T)

Note:

• This indicator should be separately reported for i) children 6-59 months, ii) pregnant and breastfeeding women and girls and iii) HIV/TB clients.

  
  

UNIT OF MEASUREMENT & ANALYSIS

Percentage of individuals

DEFINITION

This indicator measures the proportion of individuals enrolled in MAM management programmes who die during the course of treatment.

Moderate Acute Malnutrition (MAM): classification should be based on national management protocols and criteria used during programme implementation. This is most common among children 6-59 months in the population classified with WFH Z-score of ≥-3 and <-2 and/or MUAC between 115-125 and absence of Oedema. Adults usually are classified as moderately acute malnourished when body max index (BMI) is >16 and <18.5. Pregnant and lactating women and girls (PLW/G) are classified as MAM when mid-upper arm circumference (MUAC) is below 23 or 21 cm.

Mortality rate: The number of individuals in a MAM management programme that are no longer in the programme because they have died, divided by the total number of discharged individuals (i.e., cured, deaths, defaulters, non-responders and transfers) in a period (usually one month).

RATIONALE

The MAM management mortality rate is monitored to assess whether individuals receive safe and effective care in line with Sphere Standards, which expect mortality in MAM management to be very low or approaching zero. Because deaths during MAM management are rare, this indicator acts as a sensitive signal of program quality and helps identify weaknesses in case management, referral pathways, or management of medical complications. Together with other key performance such as cure rate, default rate, non‑response rate, the mortality rate provides a comprehensive picture of how well the program is functioning. Tracking it over time provides a comprehensive measure of programme performance and quality of care in line with global standards such as the Sphere Standards.

DATA COLLECTION TOOL

Data Collection Tool: Beneficiary registers

Data source: Cooperating Partner Reports

Note: The indicator should be included in all Field-Level Agreements, memoranda of understanding and other partnership agreements.

SAMPLING REQUIREMENTS

All beneficiaries enrolled in a MAM management programme must be assigned a discharge outcome—recovered, died, defaulted, or non‑responsive. Because discharge status is recorded for every beneficiary, the mortality rate should be calculated using the full caseload and must not be derived from a sample.

INDICATOR CALCULATION FOR REPORTING

This indicator is calculated by dividing the number of deceased individuals by the total number of discharges, expressed as percentage.

Mortality rate:

To calculate the number of discharges:

Final percentage value to be reported in Annual Country Report.

DATA ENTRY AND DISAGGREGATION IN CORPORATE SYSTEMS

Values are recorded in the logframe. Each value has a reporting combination which is created based on:

• Sub-activity

• Country

• Target Group

COs should different reporting combinations in COMET for the following target groups:

• Children (6-59 months)

• Pregnant Breastfeeding Women and Girls

• HIV/TB Clients

Mandatory disaggregation (for follow-up value only):

• Sex

Follow-up value is reported as: Numerator and Denominator, as per the below table.

Baseline and target values are reported as one overall value.

Recommended disaggregation for reporting outside of COMET:

• Geographical area, and based on programme needs, ethnicity, refugee status and other recognised vulnerabilities, including disability, when feasible.

BASELINE

Baselines are set only once, at one of the following points:

1. At the beginning of the CSP, or

2. When the indicator is selected for reporting after the commencement of the CSP; or

3. When a change in target, location and/or modality triggers a new reporting combination (target, location and modality) for an existing indicator.  

Baselines remain fixed for the entire CSP period and are not recalculated annually, unless applicable above.

For the first year of reporting — baseline is not applicable. Please use the “no data” function and its sub-function “Not applicable”.

For the following years, the baseline should be based on the previous year’s mortality rate.

TARGET SETTING

Annual targets:

Programmes are expected to meet the SPHERE standards (less than 3% mortality rate) annually and represent the minimum standards. However, the annual targets are expected to show gradual improvement towards the end of the project / end of CSP.

End of CSP target:

Less than 3% mortality rate, based on the SPHERE standards.

FREQUENCY OF DATA COLLECTION

Monthly

INTERPRETATION

Moderate acute malnutrition (MAM) increases a child’s risk of dying. Children with MAM are three times more likely to die than well-nourished children. High mortality rates within a programme might suggest that management of malnutrition is insufficiently provided.

Other underlying medical issues may not be addressed, or deaths are occurring unrelated to MAM management. An increase in mortality rate and/or not meeting the SPHERE standards always warrants further investigation to understand the underlying cause of death.

REPORTING EXAMPLE(S)

In Mozambique, the MAM management programme is part of the National Nutrition Rehabilitation Programme which is a key component of the Government’s efforts to manage acute malnutrition. In 2020, WFP reached 30,627 children aged 6-59 months, with 53 percent girls and 47 percent boys. That year, the programme registered overall 89.2 percent of recoveries, 7.8 percent defaults, 0.1 percent of deaths, and 1.2 percent of no responses. Despite reaching fewer beneficiaries in comparison to 2019, the national programme met the minimum standards for MAM management performance.

INDICATORS COLLECTED & ANALYSED AT THE SAME TIME

The following indicators may be reported along with this indicator:

• 14. Moderate acute malnutrition management recovery rate

• 16. Moderate acute malnutrition management default rate

• 17. Moderate acute malnutrition management non-response rate

• 7. Proportion of eligible people reached by nutrition preventive programme (coverage)

COMPLEMENTARY QUALITATIVE RESEARCH

Qualitative approaches should be used, including Focus Group Discussions to complement quantitative data to establish reasons for the performance of the indicator. Qualitative data can, in addition, inform required actions and recommendations for improvement and corrective action, to determine scale up, or to suggest follow up with beneficiaries.

DECISIONS DATA CAN INFORM

MAM management performance indicator can take several types of data-driven decisions to improve the management of MAM, including:

Program design: The indicator can help WFP to design more effective MAM management programmes. By analysing the data on the mortality rates of children who are being treated for MAM, WFP can identify the most effective treatments and adjust their programmes accordingly. This can include changes to the types of food provided, the duration of management, or the methods used to deliver the treatment.

Monitoring and Evaluation: The indicator can help WFP to monitor and evaluate the effectiveness of MAM management programmes. By collecting and analysing data on the number of children who are being treated for MAM, the mortality rates, and the overall impact of the program on the health of the children, WFP can identify areas for improvement and make data-driven decisions to adjust the programme accordingly.

Resource allocation: The indicator can help WFP to allocate resources more effectively. By analysing the data on mortality rates, WFP can make data-driven decisions on priority areas for resource allocation to maximize the impact of their MAM management programmes.

Overall, the indicator can provide valuable data for WFP to make informed decisions on how to improve the effectiveness of their MAM management programmes and ensure that children receive the care they need to recover from malnutrition.

VISUALIZATION

LIMITATIONS

Qualitative information related to underlying reasons for not meeting the SPHERE MAM management performance standard are not collected; and thus, the indicator does not state why the standard was not met.

FURTHER INFORMATION

The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response (Fourth Edition)

WHO guideline on the prevention and management of wasting and nutritional oedema (‎acute malnutrition)‎ in infants and children under 5 years