Mid-upper arm circumference (MUAC) at admission measures timeliness of admissions. This measure assesses either how early / late beneficiaries seek care for acute malnutrition or how early / late the program is able to find cases of acute malnutrition. Late admissions or those children who are admitted to the program only after they have met admission criteria for a considerable period of time are of particular interest.
Discharge outcomes should also be analysed for an acceptable pattern of admissions over time alone does not guarantee good coverage. Discharge outcome includes cure rate, defaulter rate, death rate and non-response rate.
Data on referral source provides insight to the evolution of a program's case finding and indirectly assesses the performance of the program's outreach workers. In general, a program that has good community mobilisation and awareness raising, it can be expected that source of referrals will start out as predominantly referrals coming from outreach workers and then slowly evolve into more self-referrals later on in programme implementation.
The trend of defaulters over time is one of the measures of a program's ability to retain SAM children for treatment. This measure gives an indication of specific seasons or periods in which SAM children tend to default and provides insight into the possible seasonal or event-related reasons for defaulting.
Time-to-default is a measure of how long a defaulter stays in the program before defaulting. This measure distinguishes an early defaulter (i.e. defaults within 4 weeks from admission) from a late defaulter (i.e. defaults after 4 weeks from admission). It is important to distinguish these two classes of defaulters particularly early defaulters because they are most likely current cases who are not covered by the program.
Admissions-over-time is the most important item of routine program data. Trends in admissions-over-time give program managers a quick insight as to whether the program is reaching the target population. It also acts as a gauge by which to assess the effects of changes or reforms made in the program (e.g. opening of new sites, recruitment of volunteers, initiation of outreach activities) or of events such as public holidays, harvest time or RUTF stock-outs.
Time-to-travel is a proxy measure of distance. Time-to-travel is one of a set of tools for assessing the impact on program coverage of distance of beneficiaries from program sites. The main advantage of using time to proxy distance is that a time measure generally takes into account factors relevant to travelling such as access to transportation or type of roads to name a few that are not typically considered when just considering the distance between two locations.
Mapping the home locations of beneficiaries attending a program site is one of a number of simple ways of defining the actual (rather than intended) catchment area of each program site. The actual catchment area as shown by the map represents the extent of the spatial coverage of a program and indicates whether there is possible spatial unevenness in the program's coverage.
Mapping of outreach workers' activities is one of the tools to assess the actual catchment area of a program site (as compared to the intended catchment area). The actual catchment area as shown by the map represents the extent of the spatial coverage of the outreach workers' activities and indicates whether there is possible spatial unevenness in the program's outreach activities thereby leading to spatial unevenness in the program’s coverage.
Maps of program areas are not always available or when they are, they are not of useful scale or have incomplete village locations which make them unusable for any of the mapping approaches described in the module on mapping of beneficiary locations. Mapping may also prove to be difficult particularly in urban, peri-urban, or 'shanty' areas. In these situations, the use of lists and tables of home locations, distance (or time-to-travel as proxy), number of admissions and number of defaulters can be used as alternative.
The level of performance and extent of outreach workers' activities provides an indication of a program's ability to find and recruit SAM cases which is an important contributing factor to good coverage. The level of performance of outreach workers can be assessed through different proxy indicators.
Experience with CMAM programs shows that the distance or time that carers are willing or able to walk to access services varies greatly between settings. The half-distance between markets is a tool that is used to proxy this distance. It is estimated by first identifying hamlets, villages, and towns on a map.
Semi-structured interviews are based on an interview guide. This is a set of clear instructions comprising a list of questions that should be asked and topics that should be covered in the interview.
Structured interviews expose every informant to the same stimulus. This usually means that the same questions are asked in the same order. Survey questionnaires are an example of a simple structured interview and are used in both SQUEAC assessments and CSAS surveys.
With informal group discussions, the interviewer has an idea of the topics that are to be covered in the interview, but there is no strict order in which the topics are to be covered and there is no strict wording of the questions to be asked. The discussion should be informal and conversational. Informants are encouraged to express themselves in their own terms rather than those dictated by the interviewer.