Bangladesh). This result could be due to a highly concentrated incidence of SAM in a few locations or to an inability to scale up SAM treatment. The graph is inconclusive but provides a starting point for an exploration of coverage issues.
The most recent data on coverage of SAM treatment housed by the Coverage Monitoring Network are presented in Table 5.6. These data are based on collated measurements of treatment coverage using well-established methodologies from a wide variety of countries. Median treatment coverage across sites within countries is approximately 30–50 percent. The challenge is to expand treatment coverage within the sites and then to reach other locations where SAM is prevalent. Panel 5.1 outlines some of the challenges to identifying existing coverage levels and proposes ways forward.
A final note on coverage
The focus on coverage of nutrition-specific and nutrition- sensitive programs is important. But if vulnerable populations do not have “effective coverage” (that is, if they are not engaging with effective nutrition programs), then their nutrition status will improve slowly, if at all. In other words, it is not merely cover- age that needs to be scaled up, but the effective coverage and impact of programs. This means strengthening health, food,
and water systems as well as focusing on the effectiveness of programs, on the design features that enhance impact, on the strategy and vision for scaling up, and on the capacities and resources needed for scaling up.
It should also be recognized that wasting (both MAM and SAM) and stunting can coexist in the same child, creating a need for a coordinated response. Such a response should occur not only during humanitarian crises, but also in non-emergency settings as part of a wider nutrition development agenda.
On expanding coverage, recent results from the latest Countdown to 2015 report (Countdown to 2015, 2014) sug- gest that, for the Countdown countries (where undernutrition is the primary malnutrition issue), the interventions that have the lowest coverage are the ones where coverage is improving the slowest.
To assess the potential impact of scaling up coverage of key nutrition interventions, Zulfiqar Bhutta and colleagues prepared an analysis for this report (for details, see Technical Note 2 at
www.globalnutritionreport.org). They examined the impact on stunting and wasting in Bangladesh, Ethiopia, and Pakistan of scaling up coverage of key nutrition-specific programs, plus interventions related to optimizing birth intervals and improving water, sanitation, and hygiene. The results are similar to those
TABLE 5.6 CURRENT DIRECT ESTIMATES OF COVERAGE OF SAM TREATMENT Country
Afghanistan Angola
Burkina Faso Cameroon Chad
Dem. Rep. of the Congo Ethiopia Haiti
Kenya Mali
Mauritania Nepal Niger
Nigeria Pakistan
Philippines Rwanda Senegal
Sierra Leone Somalia
South Sudan Sudan
Number of coverage estimates 1 1 4 1 9 4 2 1
13 1 1 1 4 1
10 2 1 2 1 2 4 2
26–41 35
20–73 14–41 79–89 45
20–67 25 35 41
28–61 55
37–87 33–91 35
12–17 62
83–85 24–86 43–59
50
Source: Based on data compiled by the Coverage Monitoring Network (CMN), available from CMN upon request. Note: SAM = severe acute malnutrition.
36 GLOBAL NUTRITION REPORT 2014
Range of direct estimates of SAM program coverage (%) 36 82
Median of direct estimates of SAM program coverage (%)
31
38 30
Setting Urban Rural Rural
Urban Rural Rural
Camp/rural Urban
50 30 50
Rural/urban Rural Rural Rural Rural Rural
Rural/camp Rural Rural Rural
Urban Camp
Rural/camp Camp
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