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Gaza MUAC Screening Analysis

February 2024 – UPDATED MARCH 22

Jana Daher

Dr Oleg Bilukha

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smartmethodology.org

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Meta-data

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Dataset

Level of data

Data collection period

Setting

Children health status

Sample size*

N (%) Children 6-23 months

N (%) Children 24-59 months

North Gaza / Juzoor (Jan)

Individual

2.5 weeks�Jan 14- 31

Health centers and shelters – vaccination

Not sick

1,549

1539�(99.4%)

10�(0.6%)

North Gaza / Juzoor (Feb)

Individual

4 weeks�Feb 1-29

Health centers and shelters – vaccination?

Not sick?

1,329

1325�(99.7%)

4 �(0.3%)

Deir al Balah/ UNRWA�(Middle area) (Feb)

Individual

3 weeks�Feb 5-10�Feb 18-25�Feb 26-Mar 4

Health centers in Deir Al Balah incl. Nusirate refugee camp – vaccination

Not sick

1,393

1393�(100.0%)

-

Deir al Balah/ UNRWA�(Middle area) (Mar)

Individual

1 week�Mar 5-9

Health centers in Deir Al Balah incl. Nusirate refugee camp – vaccination

Not sick

289

289�(100.0%)

-

Khan Younis / AEI

Aggregate

Feb 22?

Shelters – screening

Not sick

322

117 �(36.3%)

205 �(63.7%)

Rafah / UNRWA (Jan-Feb)

Individual

6 weeksJan 17-Mar 4

Health centers in Rafah – vaccination

Not sick

2,462*

2443�(99.2%)

19�(0.8%)

Rafah / UNRWA (Mar)

Individual

1 week�Mar 5-9

Health centers in Rafah – vaccination

Not sick

1,712*

932�(54.4%)

780�(45.6%)

Rafah / IMC (Jan-Feb)

Individual

8 weeks�Jan 6 – Mar 4

IMC hospital – triage

Mostly sick

948*

495�(52.2%)

453�(47.8%)

Rafah/ IMC (Mar)

Individual

2 weeks�Mar 4 -17

IMC hospital – triage

Mostly sick

299*

151�(49.8%)

148�(48.8%)

Rafah / MSF (Jan-Feb)

Aggregate

3 weeks�Jan 28 – Feb 11

Health Center – PHC activity

Some sick

551

253 �(45.9%)

298 �(54.1%)

Rafah / MSF (Mar)

Aggregate

2 weeks�Feb 18 – Mar 3

Health Center – PHC activity

Some sick

1,202

522�(43.4%)

680�(56.6%)

Rafah / AEI

Aggregate

Feb 22?

Shelters – screening

Not sick

844

293 �(34.7%)

551 �(65.3%)

Rafah / Med Global (Feb)

Aggregate

4 weeks �Feb 1-29

Medical points – screening

Not sick

7,327

3211�(43.8%)

4116�(56.2%)

Note: Important explanations are included in the comment panel below. Please review these notes to avoid misinterpreting the data.

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Results – MUAC GAM prevalence

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UNWEIGHTED

WEIGHTED

ESTIMATED

Dataset

N & Health status

GAM MUAC

6-59 months

GAM MUAC�6-23 months

GAM MUAC�24-59 months

Ratio

GAM MUAC

6-59 months

IPC AMN PHASE

Projected GAM WHZ

6-59 months

North Gaza / Juzoor (Jan)

1,536�Not sick

16.02%

1.60 – 5.34

6.41 – 8.90

2-3

10-13%

North Gaza / Juzoor (Feb)

1,323�Not sick?

29.25%

2.93 – 9.75

11.70 – 16.25

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16-25%

Deir al Balah/ UNRWA�(Middle area) (Feb)

1,392�Not sick

4.67 %

0.47 – 1.56

1.87 – 2.60

1-2

3-5%

Deir al Balah/ UNRWA�(Middle area) (Mar)

289�Not sick

11.46%

1.15 – 3.82

4.59 – 6.37

2

5-8%

Khan Younis / AEI

322�Not sick

12.73%

28.21%

3.90%

7.23

12.00%

3-4

14-18%

Rafah / UNRWA (Jan-Feb)

2,434�Not sick

8.01%

0.80 – 2.67

3.20 – 4.45

1-2

4-6%

Rafah / UNRWA (Mar)

1,705�Not sick

4.46%

6.67%

1.80%

3.71

3.42%

1-2

4-6%

Rafah / IMC (Jan-Feb)

939�Mostly sick

7.35%

12.45%

1.78 %

6.99

5.33%

2

5-7%

Rafah/IMC (Mar)

296�Mostly sick

5.74%

10.74%

0.68%

15.79

4.03%

1-2

4-6%

Rafah / MSF (Jan-Feb)

551�Some sick

11.80%

18.58%

6.04%

3.07

10.22%

3

12-15%

Rafah / MSF (Mar)

1,202�Some sick

2.91%

5.75%

0.74%

7.77

2.41%

1-2

3-6%

Rafah / AEI

844�Not sick

5.09%

12.29%

1.27%

9.68

4.94%

2

5-7%

Rafah / Med Global (Feb)

7,327�Not sick

4.37%

7.32%

2.07%

3.54

3.82%

1-2

4-7%

Note: Important explanations are included in the comment panel below. Please review these notes to avoid misinterpreting the data.

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Results – MUACZ GAM prevalence

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UNWEIGHTED

WEIGHTED

ESTIMATED

Dataset

N & Health Status

GAM MUACZ

6-59 months

GAM MUACZ� 6-23 months

GAM MUACZ�24-59 months

Ratio

GAM MUACZ

6-59 months

Projected GAM WHZ

6-59 months

North Gaza / Juzoor (Jan)

1,536�Not sick

15.69%

3.92 – 15.69

7.84 – 15.69

10-13%

North Gaza / Juzoor (Feb)

1,323�Not sick?

30.76%

7.69 – 30.76

15.38 – 30.76

16-25%

Deir al Balah/ UNRWA�(Middle area) (Feb)

1,392�Not sick

5.75%

1.44 – 5.75

2.88 – 5.75

3-5%

Deir al Balah/ UNRWA�(Middle area) (Mar)

289�Not sick

8.68%

2.17 – 8.68

4.34 – 8.68

5-8%

Rafah / UNRWA (Jan-Feb)

2,434�Not sick

6.20%

1.55 – 6.20

3.10 – 6.20

4-6%

Rafah / UNRWA (Mar)

1,705�Not sick

5.75%

5.60%

5.93%

0.94

5.82%

4-6%

Rafah / IMC (Jan-Feb)

939�Mostly sick

8.31%

11.43%

4.90%

2.33

7.07%

5-7%

Rafah/IMC (Mar)

296�Mostly sick

5.41%

8.72%

2.04%

4.27

4.27%

4-6%

Note: Important explanations are included in the comment panel below. Please review these notes to avoid misinterpreting the data.

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Results – MUAC SAM prevalence

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UNWEIGHTED

WEIGHTED

Dataset

N & Health status

SAM MUAC

6-59 months

SAM MUAC�6-23 months

SAM MUAC�24-59 months

SAM MUAC

6-59 months

North Gaza / Juzoor (Jan)

1,536�Not sick

2.41%

North Gaza / Juzoor (Feb)

1,323�Not sick?

4.46%

Deir al Balah/ UNRWA�(Middle area) (Feb)

1,392�Not sick

1.01%

Deir al Balah/ UNRWA�(Middle area) (Mar)

289�Not sick

1.39%

Khan Younis / AEI

322�Not sick

4.35%

10.26%

0.98%

4.07%

Rafah / UNRWA (Jan-Feb)

2,434�Not sick

1.56%

Rafah / UNRWA (Mar)

1,705�Not sick

0.59%

1.08%

0.00%

Rafah / IMC (Jan-Feb)

939�Mostly sick

2.34%

4.29%

0.22%

1.58%

Rafah/IMC (Mar)

296�Mostly sick

1.69%

3.36%

0.00%

1.12%

Rafah / MSF (Jan-Feb)

551�Some sick

1.27%

2.77%

0.00%

0.92%

Rafah / MSF (Mar)

1,202�Some sick

0.33%

0.77%

0.00%

0.26%

Rafah / AEI

844�Not sick

0.95%

2.39%

0.18%

0.92%

Rafah / Med Global (Feb)

7,327�Not sick

0.90%

1.71%

0.27%

0.75%

Note: Important explanations are included in the comment panel below. Please review these notes to avoid misinterpreting the data.

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Data Quality

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Dataset

Mean MUACZ

SD MUACZ

% Flags MUACZ (+/- 4sd)

DPS MUAC

North Gaza / Juzoor (Jan)

-0.93

1.08

0.2%

64

North Gaza / Juzoor (Feb)

-1.40

1.09

0.2%

67

Deir al Balah/ UNRWA�(Middle area) (Feb)

-0.50

0.95

0.1%

31

Deir al Balah/ UNRWA�(Middle area) (Mar)

-0.51

0.99

0.3%

28

Rafah / UNRWA (Jan-Feb)

-0.21

1.05

0.4%

57

Rafah / UNRWA (Mar)

-0.25

1.10

0.4%

28

Rafah / IMC (Jan-Feb)

-0.26

1.22

0.9%

60

Rafah / IMC (Mar)

-0.09

1.17

1.0%

56

Note: Acceptable ranges for standard deviation, percentage flags and digit preference score are as follows:

  • SD MUACZ <1.25
  • % flags MUACZ < 1%
  • DPS MUAC <15

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Empirical Evidence �Concordance between MUAC, MUACZ and WHZ

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Excluded Datasets

  • Med Global – Rafah (Jan 21 – Feb 18)
    • Sample size = 88 children
    • All children with low MUAC. Hypothesis: many children were screened but only reported children with low MUAC.
    • Provisionally included in the previous analysis after it was reported that the total number of children screened was about 5,000. It was possible to calculate the unweighted MUAC GAM prevalence (no exclusions).
    • Replaced with the latest aggregated data shared by Med Global (Feb 1-29) due to the overlapping data collection period.
  • Project Hope – Deir Al Balah (Feb 1)
    • Sample size = 289
    • All children aged either 18 months or 28 months
    • Large positive systematic bias with mean MUACZ of +1.14 (excluding flags +/-4 SD).
  • AEI – Deir Al Balah (Feb 22)
    • Sample size too small (45 children)

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THANK YOU!

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