16. Moderate acute malnutrition management default rate

16. Moderate acute malnutrition management default rate

VERSION

V5.0 - 2026.03 — Existing with revisions

INDICATOR CODE

16

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 who leave a MAM management programme before reaching any formal discharge outcome (recovered, died, non‑responsive, or transferred).

Moderate Acute Malnutrition (MAM): classification should be based on national treatment 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 breastfeeding women and girls (PLW/G) are classified as MAM when mid-upper arm circumference (MUAC) is below 23 or 21 cm.

Default rate: The number of individuals in a MAM management programme that have not attended for a defined period (e.g., two or more consecutive sessions), divided by the total number of discharged individuals (i.e. cured, death, defaulter, non-responders and transfers) in a period (usually one month).

Note: MAM Management Performance indicators (recovery, defaulter, mortality, and non-response) are only used for targeted supplementary feeding programmes. Discharge criteria can differ slightly, and definitions of national protocols need to be used to identify the type of discharge that has occurred.

RATIONALE

The default rate is tracked to assess how well a MAM management programme is able to retain beneficiaries through to completion of care. When children default; leaving the programme before achieving a discharge outcome, it can signal barriers such as access constraints, long travel distances, caregiver workload, poor service quality, or inadequate follow‑up mechanisms. Monitoring this indicator helps identify operational or contextual challenges affecting continuity of care and supports improvements in programme design, community engagement, and service delivery. A high default rate undermines recovery outcomes, making this indicator essential for understanding programme performance and overall effectiveness.

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 defaulted individuals by the total number of discharges, expressed as percentage.

Default 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 have 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 default rate.

TARGET SETTING

Annual targets:

Programmes are expected to meet the SPHERE standards (less than 15% default 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 15% default rate, based on the SPHERE standards.

FREQUENCY OF DATA COLLECTION

Monthly

INTERPRETATION

The duration of the intervention, quantity of products, provision of related services, and frequency of the distribution for MAM management have been designed to achieve the course’s impact. Failure of beneficiaries to show up for management as well as defaults negatively impact on the achievement of the intended result, that is recovering from being malnourished.

The inability to meet SPHERE default rate warrants actions to understand the origin and adapt programme strategies. For example, if defaulting is due to movement of populations (e.g. conflict), efforts need to be made to identify if services are available and/or need to be opened.

The failure to meet SPHERE standards is a proxy for quality of care. Together with coverage, this indicator can be used to assess if the programme is achieving the intended result.

Consider external factors such as:

• Morbidity patterns

• Levels of undernutrition in the population

• Levels of food insecurity in the households and population

• Complementary interventions available to the population (including general food assistance or equivalent programmes)

• Capacity of existing systems for service delivery

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

• 15. Moderate acute malnutrition management mortality 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

Program design: The indicator can help WFP to design more effective MAM management programmes. By analysing the data on the default recovery 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 treatment, 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 te default 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 the expected default 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