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Improving SAM caseload estimates through analysis of incidence factors

New York City (United States of America) | Washington D.C.

BACKGROUND & RATIONALE Child undernutrition is a major contributing factor to child mortality, disease, and disability. High-impact interventions are available to address child undernutrition. Furthermore, effective treatment modalities have been devised to treat children affected by severe acute malnutrition (SAM) with both in-patient and out-patient approaches.

The basis of SAM treatment programming is the estimated number of cases of SAM that will develop during the period of the programme (SAM burden), as that number of anticipated cases guides planning on human, institutional and financial resources required.

The emergency responses to the 2011 nutrition crisis in the Horn of Africa and the 2012 food security and nutrition emergency in the Sahel highlighted inconsistencies in the way SAM burden was calculated and communicated by different countries. In an effort to improve UNICEF’s accuracy and consistency, the UNICEF Nutrition in Emergencies Unit undertook a standardization of the process. Different formulas were reviewed; external experts, senior nutrition advisers and managers in UNICEF, the World Food Programme (WFP) and the World Health Organization (WHO) were consulted; and UNICEF Country offices (COs) participated in webinars to understand the changes and implications for each country. The resulting guidance is the basis for annual SAM supply forecasting. An update in 2014 provided updated guidance on using subnational survey data in SAM burden forecasting with technical input from CDC, and can be found in Annex A of UNICEF’s SAM programming guidance . The current UNICEF SAM programming guidance defines the burden of SAM as the sum of the existing (prevalent) cases and the new (incident) cases. Calculation of these figures relies on prevalence of SAM, population estimates, and an incidence factor for SAM, which are then to be calibrated with programming data if possible.

While the adoption of a global guidance for SAM burden has been helpful to standardize programming, technical limitations the components used for calculation, and therefore overall guidance, remain. The SAM incidence factor of 1.6 was developed based on historical data, however there are indications that there is greater variation between countries and that routine survey, programme and surveillance data may be useful in the generation of country specific SAM incidence factors. The issue is of interest to a wide range of partners, including national governments as well as the range of nutrition actors engaged in this area. For example, Global Nutrition Cluster partners in October 2015 calling for improving SAM burden estimation guidance in a way that takes into account MAM caseload estimate development as well at the Global Nutrition Cluster meeting.

Improving methods for determining SAM incidence factors is the core area of work for the consultancy, recognizing that some of the other limitations to the global guidance- such as the discrepancy between prevalence based on weight-for-height versus MUAC and variation with seasonality- require further work through other processes.

PURPOSE Given UNICEF’s corporate commitment to working with national governments on scaling up SAM management globally, improved tools for country level staff to improve programming is a priority. The overall purpose of the consultancy is to improve methods for generating SAM burden estimates through improved methods

The work to be undertaken through this contract will help inform the update to global guidance for SAM programme planning. Where possible and relevant, the analysis will engage with stakeholders involved in generating global modelled estimates of child malnutrition (eg. WHO, World Bank, UNICEF) and stakeholders engaged in technical discussions on MAM caseload estimates. The work is not however intended to replace these complementary lines of work.

EXPECTED RESULTS: (MEASURABLE RESULTS) The main objective of the research is to understand if, how, and the extent to which SAM incidence factors vary between country contexts in order to improve programme planning tools, specifically caseload estimates. This consultancy will, in particular, address the following questions: • What are the gaps in the distribution and quality of available data for SAM incidence? • Where data exists, to what degree does SAM incidence vary between countries? • Where data exists, to what degree does SAM incidence vary subnationally and seasonally? • What are the minimum capacity and data requirements to generate country-specific SAM incidence? • What are the potential implications of variations in SAM incidence factors on global modelling and joint estimates of SAM burden?

The specific objectives of the assignment are to: • Issue a call for available survey and programme data to conduct analysis of SAM incidence • Provide a stocktake of gaps in available survey and programme data to inform future data collection • Consolidate and clean available country level data relevant to the SAM incidence analysis • Perform country level data analysis of SAM incidence and generate country specific SAM incidence factors, and provide an analysis of the implications of the observed level of variation for SAM programming • Facilitate consultation with technical experts and stakeholders on the application of available methods for calculating country specific SAM incidence • Provide evidence for UNICEF and relevant stakeholders to update SAM caseload estimate guidance

DUTY STATION The consultancy is home-based, with travel to NYHQ for inception and validation.

TIMEFRAME The consultancy will be carried out in 145 working days conducted over the period September 2016-March 2017

Start date: 20 August 2016 End date: 31 March 2017

DELIVERABLES DURATION (ESTIMATED # OF DAYS) Deadline - Outline of the approach and structure of the assignment and report, including preparation and call for data and desk review. 20 days, 21 September 2016
- Data analysis, including data cleaning, 64 days, 21 December 2016 - Draft Detailed Report (with Executive Summary 20 21 January 2017 - Technical consultation and development of updated guidelines 21 days, 21 February 2017
- Detailed Report (with Executive Summary) 20 22 March 2017 TOTAL 145 days

Key considerations

The assignment will be carried out through desk study and data analysis, and is essentially expected to involve (but not limited to) the following: - Build on existing published and grey literature on SAM caseload estimate guidance and evidence - Review existing survey, programme and surveillance data availed through a call for data to relevant stakeholders, identifying gaps in available data to inform further data collection  - Consult with relevant stakeholders working in the area of forecasting or modelling SAM caseloads - Consult with relevant operational partners and users of the guidance *- Facilitate technical discussion of findings and generation of recommendations for guidance for SAM caseload projections


  • PhD in Epidemiology and Nutrition or related fields with specific knowledge and expertise in nutrition data analysis 
  • At least 10 years professional experience in nutrition programming, policy and/or analysis 
  • Experience in writing and/or publishing on policy and programmatic aspects of nutrition thematic areas including conducting and directing research, data collection and publication 
  • Familiarity with SAM programming operations at country level, with knowledge of the global nutrition architecture and strategic stakeholders/partners is required; 
  • Highly proficient in use of English with the ability to write in a clear and practical manner

Applicants are requested to apply to

Applications must include: • Cover letter, • CV, and • P-11 form
• Indicate where you heard about this advertisement

Please indicate your ability, availability and daily/monthly rate (in US$) to undertake the terms of reference above. Applications submitted without a daily/monthly rate will not be considered.

Before applying, please make sure that you have read the requirements for the position and that you qualify.
Applications from non-qualifying applicants will most likely be discarded by the recruiting manager.

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  • Organization: UNICEF - United Nations Children’s Fund
  • Location: New York City (United States of America) | Washington D.C.
  • Grade: Senior - Internationally recruited position - Senior level
  • Occupational Groups:
  • Closing Date: 2016-08-12

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