United Nations System
Standing Committee on Nutrition

 

SCN Working Group on Nutrition in Emergencies

held during the ACC/SCN's 29th Session in Nairobi, Kenya, on Thursday 5 April 2001

Chair: Anna Taylor, SCF, UK
Co-Chair: Sultana Khanum, WHO
Rapporteurs: Frances Mason, AAF, UK; Annalies Borrel, USA

The report is divided into four sections:

  1. Follow-up of Recommendations from 2000
  2. Proposals for 2001-2002
  3. Agency Updates
  4. Recommendations for Action

 

A. Follow-up of Recommendations from 2000

1. Assessment of Adult Malnutrition

Adult malnutrition was initially put on the agenda at the ACC/SCN meeting in April 1999. In 2000, a presentation was made of the most recent field experience. Later on in the year, RNIS supplements were published summarising interim recommendations for the assessment of adult 1 and adolescent 2 malnutrition in emergencies. This led to a special meeting held during the SCN's 28th session in Nairobi in April 2001  3.

The aim of the special meeting was to reach a common understanding of the recommendations on the assessment of malnutrition in adults and to identify practical steps to improve practice in the assessment of adult malnutrition. Following individual presentations, and plenary discussion with an expert panel, the working groups came up with the following interim recommendations for operational agencies in six areas. Further steps to be taken by the thematic group were also discussed.

  • When to consider assessing adult malnutrition
  • Pre-requisites for surveying adults
  • Survey methodology
  • Indices
  • Presentation
  • Selective feeding
  • Research needs

When to consider assessing adult malnutrition   Assessment of adult malnutrition should be considered under the following circumstances: if the crude mortality rate (CMR) increases in relation to the under 5 year mortality rate; if many adults are present at existing supplementary feeding centres; where there are very high rates of under 5 malnutrition in the absence of an epidemic outbreak; if there is reasonable doubt that the child malnutrition rates do not reflect the nutritional status of the general population; if the populations are entirely reliant on food aid and if data is required as an advocacy tool to leverage resources.

Pre-requisites for surveying adults   In all situations a thorough contextual analysis is required prior to carrying out an adult anthropometric survey. Adequate expertise, clear objectives and sufficient resources are all pre-requisites to undertaking such surveys.

Methods   A nutritional causal analysis must always be undertaken in conjunction with adult 4 anthropometric surveys. Adult surveys require adaptation of the standard sampling used in under 5 year anthropometric surveys. The choice of methodology should take into consideration potential selection bias (adults are often away). Surveys of older adults only may be appropriate in some situations

Indices   The recommended indices that should be used are Cormic adjusted BMI (population specific or Norgan correction) & MUAC. Using MUAC alone may be a useful rapid alternative in a very acute situation. Functional outcomes (e.g. step test, hand grip) should be collected in conjunction with anthropometric data.

Presentation   Currently there is no consensus on exact cut-offs of anthropometric indices for adults. Therefore it was recommended that a range of cut-offs are reported. The definition of the indicator must always be described and frequency distributions presented.

Selective feeding   Alternative strategies to selective feeding programmes should always be considered. Where selective feeding programmes are implemented, admission and discharge criteria should be based on anthropometric indices, social factors and clinical signs. Indicators for monitoring should include weight gain (minimum target 5g/kg/day) and functional ability.

Research Needs   The following research needs were prioritised:

  • Investigate functional significance of proposed indices (mortality & morbidity)
  • Investigate changes in MUAC by sex, age, ethnic group and context
  • Investigate the aetiology of adult malnutrition including adult nutritional oedema. Health and food security indicators should be considered in this investigation
  • Develop anthropometric and functional methods to differentiate between acute and chronic undernutrition.
  • Develop anthropometric methods for assessment of undernutrition in the 18-25 year group, in older persons and in adolescents need further development.

2. Infant Feeding in Emergencies operational Guidance

Operational guidance for Emergency Relief Staff and Policy-Makers

During an interagency meeting held in November 1999 on infant and young child feeding in emergencies, a need for interagency consensus on operational guidance was highlighted. While a number of specific technical documents already exist (eg WHO, Linkages, Sphere Guidelines), there is a obvious gap in practical guidance that can be used by both policy-makers and relief staff.

The interagency working group on Infant Feeding in Emergencies has prepared a document entitled Infant and Young Child Feeding in Emergencies: Operational guidance for Emergency Relief Staff and Policy-Makers. The document is concise, practical and provides a list of reference material including websites for further information.

Comments on the draft from different agencies is required by 31st May 2001. Comments should be sent to Fiona O'Reilly at Fiona@ennoline.net.

Multi-agency support to the document will strengthen its effectiveness. Indication for support to the document should be provided by June 30th 2001 by which the time the document will be finalized. ENN Online would like your agency to show support for this document.

To date, the document has the provisional support pending final revisions ofAction Against Hunger / Action Contre la Faim, Department for International Development, Emergency Nutrition Network, Fondation Terre des Hommes (Suisse)GIFA, GOAL, Institute of Child Health, LINKAGES, MSF Holland, Oxfam GB, Save the Children UK, Save the Children US, Tear Fund, UNHCR, UNICEF.

Training Modules for Infant feeding in Emergencies

Training modules for Infant Feeding in Emergencies have been prepared. The purpose of these materials is to prepare emergency relief staff to support appropriate infant feeding and to describe the process of applying operational guidance. This work is the product of collaboration between WHO, UNICEF, LINKAGES, IBFAN, ENN and further contributors.

The training materials are divided into two modules. Module One is based on advocacy and orientation, aimed at decision makers, all field staff and national health staff. Core materials for this module are designed for one-hour training orientations. Additional optional materials are available if required. A full set of materials includes presenter's notes, overheads and copies of the manual for each participant. Module Two is targeted to health and nutrition staff. This module aims to increase technical knowledge and practical skills of health workers. The module is developed for use in a variety of environments and provides materials for approximately four hours of training. Ideally presenters need to have expertise in both emergencies and in breastfeeding.

The materials for Module One are now available on CD-Rom and as a PowerPoint presentation and are available for downloading at ENN Online. Feedback is requested from all users before the finalisation of the final pack. Module Two is yet to be finalised, but should be disseminated by the end of 2001.

3. Matrix for identifying gaps in knowledge, skills and practice in Emergency Nutrition

The need to prioritize the gaps in knowledge, skills and practice in emergency nutrition, was identified in last year's meeting. This led to the design of a matrix. A preliminary format was designed last year which has subsequently been revised. The task however was delayed by the fact that different individuals have had to take responsibility for moving the process along. Furthermore, there is still some scepticism within the Working Group on the purpose and usefulness of the matrix.

The matrix is based on five specific areas (methodologies, guidelines, field guides, training, research needs) which are delineated according to seven population groups. The matrix is repeated for each of the following broad areas of work:

  • Assessment of wasting
  • Assessment of micronutrient deficiencies
  • Assessment of household food security
  • Assessment of feeding programmes
  • Monitoring of feeding programmes
  • Control and treatment of severe and moderate malnutrition
  • Control and treatment of micronutrient deficiencies.

Once the format of the matrix has been further revised and developed, it is anticipated that agencies will complete the matrix by providing information on specific agency guidelines, training materials etc. for each of the age groups. The final completed matrix will reflect cumulative information. The process will enable specific gaps to be identified and therefore provide an advocacy and planning tool for the Working Group. Comments should be provided to Zita Weise Prinzo at WHO (email weiseprinzoz@who.int)

4. WHO Manuals, documents and training material

During last year's meeting, the working group expressed serious concerns about the fact that the WHO publication Management of severe malnutrition: a manual for physicians and other senior health workers was costly and inaccessible to many individuals, agencies and institutions. The manual is now available on the WHO website. WHO is preparing training modules to accompany the manual. While the training modules are primarily targeted to hospital facilities, they can be adapted for community and rural situations. The seven modules comprise of:

  1. Introduction
  2. Principles of care
  3. Initial management
  4. Feeding
  5. Daily care
  6. Monitoring and problem solving
  7. Involving mothers in care

The training module will also provide practical ready-to-use laminated cards with:

  • Feeding regimes
  • Antibiotic protocols
  • Weight for height assessment

The training modules should be available in April 2001.

The document Management of Nutrition in Major Emergencies (WHO, HCR, WFP) will be made available on WHO website during April 2001. The document is also on CD-Rom. Currently, hard copies are still only available at a cost. WHO will consider making hard copies available free (see Recommendations).

B. Proposals for 2001-2002

1. Community Based Therapeutic care

Dr Steve Collins (Valid International) presented a proposal for community based therapeutic care (CTC). The concept aims to integrate emergency nutrition interventions with longer-term programmes by establishing community based structures that can be re-activated in future emergencies. Although the need for, and strengths of, therapeutic feeding centers (TFC) are acknowledged (particularly for anorexic, hypothermic, hypoglycaemic, dehydrated and septicaemic cases), concerns regarding the related high costs, necessary resources and coverage of such feeding centers were presented. Potential negative impacts of TFCs, such as the removal of the mother from the family, the decrease in the household economic production and the increase in public health problems due to cross infection were also noted.

Community therapeutic feeding is the treatment of severe malnutrition at home, using Ready to Use Therapeutic Food (RUTF), mother to mother support, follow-up of cases and a strong networking system. The RUTF provides the nutritional equivalent to Formula-100 and can be given to children with uncomplicated severe malnutrition (those with a good appetite, no persistent diarrhoea and no major medical complications) and to early discharges from local, small TFCs or local clinics, after initial complications and severe infections have been treated and appetite has returned.

The implementation of a CTC is through a weekly intensive supplementary feeding programme. Following anthropometric screening, the RUTF is provided with systematic medication (vitamin A, mebendazole, measles vaccination and broad-spectrum long acting antibiotic) and education sessions. Successful mothers whose children progress well are identified and 'mother to mother' training is set up. Community groups ensure the follow-up of the cases, linking up with other groups to make local networks. Through such an approach, it is intended that the CTC empowers communities to address extreme food insecurity and famine through development principles. It is believed that emergency CTC programmes can utilize efficiently large quantities of humanitarian resources faster than TFC programmes, and that these CTC programmes can evolve seamlessly into developmental "hearth model" programmes. In times of emergency, developmental hearth programmes can easily scale-up into rapid effective CTC emergency interventions. This should improve timeliness, coverage and cost effectiveness.

Research on CTC programmes is currently limited. Trials have been undertaken in Ethiopia in 2000 by Concern Worldwide and Oxfam. In a study undertaken in Bangladesh 5, mortality rates were equal in three groups of severely malnourished cases: hospital, day care and domiciliary care. The follow-up of morbidity is less in the domiciliary group and the cost/patient in this group is <25% of the hospital group.

Dr Steve Collins concluded his presentation by reinforcing the need for more 'imaginative' nutritional interventions during emergencies and the belief that the Community Based Therapeutic Care will add flexibility to current practice, albeit not applicable in every situation or for every child. Implementation must involve conscientious data collection to evaluate the overall impact.

2. SCN/RNIS Publication on The Meaning and Measurement of Acute Malnutrition in Emergencies

Dr. Helen Young presented a proposal for a new SCN/RNIS publication on "The Meaning and Measurement of Malnutrition in Emergencies: the origins of good practice and actual practice". The main objective of the review is to produce a technical review of the scientific basis and origins of current field practice. The document will aim to serve as a reference point for agency policies, guidelines and training initiatives. The document will be prepared for a wide range of users including nutrition specialists in Government, UN agencies, NGOs universities, research institutes and advisory bodies and will be distributed through the SCN.

The need for such a review is based on the fact that while the majority of previous technical documents have necessarily focused primarily on good practice guidelines, there is a need for an in-depth explanation of the origins and scientific basis of good-practice. Agencies and individuals working within the humanitarian nutrition sector would benefit from a better grasp and understanding of the foundations of technical recommendations.

The document is likely to comprise of seven chapters including; (i) introduction, (ii) methodological approaches, (iii) sampling and quantitative analysis, (iv) qualitative methodologies, (v) tools for interpretation, (vi) information for action and (vii) conclusions and future directions. The process of developing the document, as agreed by the Task Force, will be co-ordinated by a thematic group (Helen Young, Saskia van der Kam, Frances Mason and Arabella Duffield). The process will require submitting the final proposal to interested donors, nominating experts to research and prepare specific chapters and finally compiling, editing and reviewing the document.

3. Capacity Building in Training Initiatives in Emergency Nutrition

Dr. Helen Young presented an overview of a number of training initiatives that are currently being undertaken in the humanitarian nutrition sector. These initiatives are part of a wider strategy to professionalize the response to disasters. It is widely acknowledged that there is an urgent need to invest in human resources as a means of addressing the needs in emergencies more effectively. This real need to invest in human resources through training is based on a number of reasons: (i) agency personnel are expected to operate in complex political and social environments where multiple stakeholders are engaged and where work is governed by humanitarian principles; (ii) multiple donor evaluations have indicated that the failure of relief responses continue to result from poor practice, lack of technical skills, a failure of programmes to monitor impact of programmes and poorly informed management decisions; (iii) there is a need to move beyond focusing merely on technical knowledge but also to strengthen decision-making capacities, that are based on a thorough analysis combined with action-based strategies that have a sound technical foundation.

The World Food Programme/Tufts University Food and Nutrition Training Initiative is one example of a major training initiative that is ongoing. This training initiative was undertaken in a number of stages: beginning with a review of the needs for training within WFP; the development of Food and Nutrition Handbook; development of training materials; implementation of four regional workshops and subsequent satellite workshops. The training materials are currently being developed into a Trainers Tool Box and will be available for wider dissemination. A recent evaluation of the training demonstrated that WFP participants considered the training extremely relevant to improving their work. Other training initiatives that are currently being undertaken or that are in a development phase include; UNICEF Health and Nutrition Training; SPHERE, MSF, AAH/ACF, Merlin/NutritionWorks/IHE, ICRC HELP and Interaction/Columbia University.

Training, therefore is considered one important and essential tool for capacity-building. While many training initiatives to date have generally been driven from agency head-quarters, there is a need and scope for institutionlizing training capacity on a regional basis. The Africa Nutrition Capacity Development Initiative, which was presented at the SCN Working Group on Capacity Building meeting, provides one potential forum through which training initiatives can be channelled. The priorities of this regional initiative are; advocacy, client-focused training, action-oriented research, promotion regional collaborative responses and networking. There is potential for harmonizing current training efforts through collaborative training initiatives, particularly if training encompasses a number of guiding principles such as; tailored training for different stakeholders i.e. policy/decision makers, programme planners, programme implementers and communities; the use of real-life case-studies and the use of participatory-based training approaches. This degree of harmonization in any collaborative efforts could be minimal e.g. merely sharing information on training materials, or could be substantial e.g. developing a comprehensive training strategy. A comprehensive training strategy for nutrition in emergencies would involve a number of steps; identifying the needs and gaps, assessing resources including technologies and finally developing a strategy which would include establishing regional partnerships and mechanisms for tailoring and adapting generic training material to specific contexts.

Finally, a number of initial actions for moving forward a comprehensive collaborative training initiative that would encompass a regional focus, may involve (i) preparing a central directory of training materials, (ii) determining the level and type of interest in such an initiative (iii) an initial meeting to discuss longer-term training strategies.

C. Agency Updates

Refugee Nutrition Information System (RNIS)

Serious consideration has been given to including in the RNIS nutritional information from natural disasters, following a request during last year's Working Group meeting. A review was carried out during the year to see whether this would be feasible. The decision is that the RNIS would continue to report on refugees and displaced populations in conflict situations and that natural disasters would not be included. The reasons include:

  • Information in natural disasters is usually collated and disseminated by local or regional institutions
  • This RNIS could not necessarily access the same quality of data for natural disasters
  • The RNIS (based in Geneva) does not have the resources to take on additional work. However, if the RNIS were to be regionalized it may be possible to expand coverage.

Emergency Nutrition Network

The Emergency Nutrition Network (ENN) originated out of an interagency meeting in Machakos in 1994. The broad purpose of the ENN is to try to capture lessons learnt in the field of emergency nutrition and to identify research needs. This is primarily shared through the publication of articles, summaries of research and evaluation findings in The Field Exchange, which is widely disseminated among the nutrition community.

  • The ENN, which has become a not-for-profit organisation in the past year, has provided an agency participation forum, aimed at getting agencies more actively involved.
  • The ENN has recently created a list of guidelines and websites for nutrition in emergencies, which is available on the ENN website, www.ennonline.net.

Institute of Child Health

In 2000 the Institute of Child Health (ICH) and the Centre for Disease Control (CDC) began a 22 month project on 'Enhancing the nutritional status of refugees: women, children and adolescents in Africa by addressing micronutrient deficiencies'. The aim of this project (funded by UNHCR and UNFIP) is to improve public health of refugee populations and addressing micronutrient deficiencies. The project is split into three sub-contracts with an east Africa focus (Tanzania, Kenya, Uganda, Ethiopia).

Activities planned for the current sub-agreement are

  • Development of field friendly assessment methods for micronutrient deficiencies
  • Assessment of the effectiveness of multiple micronutrient supplementation of pregnant women in refugee settings
  • Evaluation of the effectiveness of iron cooking pot provision as a strategy to reduce anaemia
  • Country based needs assessments and intervention planning (Uganda, Ethiopia, Kenya)
  • Software development

Activities to date include an ongoing survey in Kakuma, Kenya with further surveys being undertaken in Kenya, Uganda and Ethiopia; a training workshop on improving recognition and detection of deficiencies; the production of training package for survey teams; the improvement of laboratory methods for detection of pellagra and scurvy; pre-planning and site identification for micronutrient supplementation trial; revision of NUTVAL application and intervention planning

UNICEF

Core Corporate Commitments which have been approved by the UNICEF board in 5/2000 are based on four principal areas of action:

  • rapid assessment, co-ordination
  • programme commitments (health and nutrition
  • education
  • child protection and water and sanitation) and operational commitments.

Other key updates from UNICEF in 2000-1 are the following:

  • Emergency Nutrition training for the staff
    • Training activities are being further developed in co-operation with academic and other relevant partners. Combined training of health and nutrition staff is envisioned.
    • UNICEF are guiding the implementation of the Core Corporate Commitments and MoUs between the sister agencies (UNHCR, UNICEF)in the frame of the regular country programming.
  • Advocacy regarding nutrition aspects of emergency response:
    • Advocacy issues include the sensitisation of donors on various aspects of emergency nutrition response to improve timeliness and quality of the work; specifications/modifications of new or existing products used in emergencies, and adequate fortification of products.
  • Co-operation with other UN agencies in developing various guidelines and programming documents:
    • For example Infant feeding in Emergencies, and Guidelines for Estimating Food and Nutrition needs in Emergency situations.

UNHCR / WFP Joint Food and Nutrition Activities

In early 2000, UNHCR and WFP were engaged in discussions to address micronutrient deficiency among refugees. A two-day session was organised by UNHCR in February 2000 with participation of WFP, WHO, CDC and ICH. The resulting programme is discussed above (see ICH).

The WFP/UNHCR Memorandum of understanding (MoU) governing the delivery of food aid to refugees and displaced populations has been revised and is expected to capture the recent developments in both agencies. This will be produced later this year. In addition to the global MoU, mechanisms for operational co-ordination have been discussed in the area of needs assessment, programme evaluation, information sharing and resource mobilisation.

The WFP/UNHCR published edition of Guidelines for estimating food and nutrition needs during emergencies of 1999 is being revised together with WHO and UNICEF. The revised version is expanded to include breast-feeding, micronutrients, adult malnutrition and other issues on logistics and food management.

WFP

In 2000 the WFP Food and Nutrition Handbook was released with the objective of making the organisation's knowledge base concerning essential food and nutrition issues more accessible to WFP staff. Using the handbook as a resource document, a set of multi-media training materials were designed and piloted in 2000 and 2001. To assist with this undertaking and ensure continuity in the future, WFP has engaged Dr Helen Young of the Feinstein Famine Centre, Tufts University, Boston. The first training took place in Nairobi in April 2000, subsequent trainings have been held in Kampala, Addis and Rome. To date over 100 WFP staff at all levels have been trained, from Food Aid Monitors to Country Director.

  • WFP is currently researching into the fortification of cereals on site.
  • A pilot project of mobile mills has been initiated in Ethiopia and Tanzania.

MSF

MSF is currently working on the second addition of their nutrition guidelines. Amongst the issues addressed are assessments, nutrition standards, and the implementation of selective feeding centres.

WHO

WHO has produced a publication list for nutrition and health in emergencies. This can be accessed on the WHO website.

USAID

  • A commodity reference guide, giving information on all the food products that are provided by USAID has been produced in draft form. Comments on this would be greatly appreciated.
  • USAID are working with the National Academy of Science on the production of a new high density ration (similar to BP5). This should be ready for pilot testing later this year.

D. Recommendations for action

1. Assessment of Adult Malnutrition

A one-day special meeting on "Assessment of Adult Malnutrition in Emergencies" was held on Wednesday 4th of April 2000. Consensus was reached on some broad principles. Recommendations and a report are available.

Through a thematic group a strategy is to be developed which will include the following:

  • Dissemination of current materials including the special meeting output
  • Development of a research agenda
  • Establishment of a central repository for raw data
  • The development and dissemination of software to assist in analysing data
  • The preparation of a protocol for capacity building which includes an inventory of tools for training

While some consensus has been reached, there is still a need for continued operational research to work towards more concrete guidance. This need has become more urgent as a greater number of agencies become involved in adult intervention programmes.

Focal Point for Thematic Group: Dr Peter Salama

2. Matrix for identifying gaps in knowledge, skills and practice in Emergency Nutrition

  • Feedback to WHO is required on the format of the revised matrix.
  • Agencies are requested to provide their analysis of existing gaps within the matrix.

3. WHO reference materials

  • WHO is urged to make available free hard copies of the two reference documents; Management of Severe Malnutrition and Management of Nutrition in Major Emergencies.

While it is important that these documents are freely available on the web, it is important that they are also available to those that do not have access to the internet.

4. Infant and Young Child feeding in Emergencies

Following the dissemination of the near-final draft of the "Operational Guidance for Emergency Staff and Policy-Makers", (which already has the support of 15 UN agencies, bilaterals and NGOs) - the remaining actions that need to be taken are:

  • The incorporation of final comments from implementing agencies, which must be submitted by May 31st 2001.
  • Agencies are urged to indicate their support of the Operational Guidance to Fiona O'Reilly by September 30th 2001.
  • It is recommended that the document be translated into French, Spanish, Portuguese, Russian.

The need for operational guidance to be accessible to technical and non-technical actors has been clearly established. This document aims to be practical, concise, provide specific references and translates policy into recommended practice.

  • Following the completion the 1st training module for infant feeding in emergencies, it is intended that the 2nd training module will be completed within the next year.
  • Feedback from the initial phase of operationalizing the 1st module will be complied and incorporated into further development of the module.

5. Community Therapeutic Feeding

Following the proposal by Dr Steve Collins to implement therapeutic feeding through a community based programme, it was recommended that:

  • Interested agencies / individuals should contact Dr Steve Collins for collaborative work
  • An up-date on progress should be presented at the ACC/SCN meeting in 2002.

6. SCN/RNIS Publication on The Meaning and Measurement of Acute Malnutrition in Emergencies

A thematic group has been formulated to spearhead the proposal to produce a technical review of the scientific basis and origins of current field practice. The following steps need to be taken:

  • The proposal will be shared for consultation with the entire working group
  • Feedback should be provided to Dr Helen Young on the breadth, scope and content of the proposal.
  • Authors should be nominated and/or propose themselves to prepare specific chapters of the publication.
  • The thematic group will oversee progress and finalisation of the document.

Despite considerable technical, policy and operational progress, there is still an urgent need to carry out a further in-depth review on the meaning and measurement of acute malnutrition in emergencies. In order to advance and develop our practical tools, we need to learn from actual experience as well as consider the important technical issues.

Focal Point for Thematic Group: Dr Helen Young

7. Capacity Building in Training Initiatives in Emergency Nutrition

  • Links with the working group on capacity building will be established
  • A comprehensive strategy for training initiatives in emergency nutrition will be formulated
  • A regional focus for these initiatives is advised.
  • A thematic group to lead this process will be formed.

A number of agencies are currently undertaking training initiatives in emergency nutrition, for example Tufts University/WFP; Sphere, WHO training module on treatment of severe malnutrition (forthcoming), UNICEF training modules, IHE/Nutrition Works/Merlin, AAH. There is a need to consolidate and share training tools and ensure such tools and training is accessible by non-technical, management and technical staff alike.

Focal for Thematic Group: Annalies Borrel

8. Co-ordinating Mechanisms for the Working Group

The Working Group will continue to receive support from both the RNIS Coordinator and the Emergency Nutrition Network (ENN) Coordinator.

A task force made up of approximately 10 people will continue to lead the work of the Working Group in 2001-2002. Membership may be reduced to include representatives from a range of agencies who are in a position to actively participate and make a significant time contribution.

Thematic groups within the Working Group have been identified to spearhead specific areas of work.

 

1 Collins S. et al. Assessment of Adult Malnutrition in Emergencies. ACC/SCN July 2000.

2 Woodruff B., Duffield A. Assessment of Adolescent Malnutrition in Emergencies. ACC/SCN July 2000.

3 The session was made possible through the support provided to the Food and Nutrition Technical Assistance (FANTA) Project by the office of Health and Nutrition of the Bureau for Global Programs Field Support and Research at the US Agency for International Development.

4 Adults defined as over 20 years of age.

5Khanum S, Lancet '94 & AJCN '98.