United Nations System
Standing Committee on Nutrition

RNIS 41 - April 2003

Listing of sources
Abbreviations used in the text
Nutritional Assessments
Notes on surveys quoted in RNIS # 41
Indicators and classification
 

Listing of sources

Greater Horn of Africa

Somalia

AFP 21/02/03 Somali peace talks bogged down by confusion, disagreements

FSAU/FS 03/03 Monthly food security report

FSAU/N 02/03 Monthly nutrition report

FSAU/N 03/03 Monthly nutrition report

OCHA 02/01/03 Somalia: about 30 killed in renewed fighting in Puntland

UN Co-ordinator 12/03/03 UN humanitarian co-ordinator deeply concerned about worsening Resident humanitarian situation in Baidoa 

Sudan

AAH-USA 01/03 Anthropometric nutrition survey, children under-five years old, Panomdit and Chuei payams, Sobat county

ACF-F 12/02 Nutrition anthropometric survey, summary report, Bentiu and Rub Kona, Unity state

ACF-F 12/02 Nutrition anthropometric survey, summary report, Juba

ACF-F 01/03 Food security update, Benitu and Rob Kona, August-December 2002

GOAL 08/02 Nutrition survey report, Kassala IDPs, Kassala state

GOAL 08/02 Nutrition survey report, Malakal and Sobat river basin, Upper Nile state

OCHA 04/02/03 Sudan: government, rebels sign new MOU on cessation of hostilities

OCHA 05/02/03 Sudan: oil displaced allowed to return home

OCHA 22/01/03 Sudan: humanitarian access granted for Kassala state, southern Blue Nile

FEWS 20/02/03 Monthly food security report

WFP-South Sudan 01/03 Nutrition status data 2002 

West Africa

Ivory Coast

AcF-F 02-03/03 Rapports d'évaluation nutrition/sécurité alimentaire, ville de Daola et villages tampon (Bonufla, Belleville, Zaibo), ville de Man et zones rurales proches, Korhogo, Dabakala, Bouake, zone rurale and Odienne

Government of Côte d'Ivoire 24/01/03 Crise en Côte d'Ivoire: Les accords de Marcoussis

OCHA 07/03/03 Crisis in Côte d'Ivoire situation report n° 5

PANA 19/03/03 ECOWAS deploys 1,258 troops in Côte d'Ivoire

UNHCR 21/03/03 UNHCR briefing notes

WHO 12/02/03 Conséquences de la crise socio-politique sur le secteur de la santé en Côte d'Ivoire

WFP 07/03/03 WFP emergency report n° 10

Guinea

OCHA 27/03/03 Guinea: Humanitarian briefing pack March 2003

UNHCR 12/02 Assessing refugees self-reliance: a food economy assessment, Kountaya and Telikoro refugee camps, Kissidougou,

Guinea, September-October 2002

Liberia

ACH-S 10/02 A silent tragedy, impact of the war on the humanitarian situation in the Lofa county, Liberia

OCHA 13/03/03 Liberia: IOM appeals for US $1.5 m to evacuate third-country nationals

OCHA 25/03/03 Displacement in central Liberia could overburden humanitarian resources

OCHA 31/03/03 Humanitarian voices- OCHA regional support office for West Africa, January-March 2003

OCHA 02/04/03 Guinea humanitarian update: influx from Liberia into Guinea

OCHA 09/04/03 Liberia's humanitarian needs increase, as security situation deteriorates

OCHA 11/04/03 Liberia: armed groups attack IDP camps

OCHA 11/04/03 Liberia: two more IDP camps attacked

Reuters 18/02/03 Liberian minister says fighting on four fronts

UNHCR 07/03/03 UNHCR briefing notes: Liberia, Afghanistan, Central African Republic

UNHCR 04/04/03 Refugees flee in all directions as conflict spreads in eastern Liberia

UNHCR 04/04/03 UNHCR briefing notes: Liberia, Iraq region

UNHCR 10/04/03 Hundreds flow back into Côte d'Ivoire amid Liberian conflict

WFP 14/02/03 WFP emergency report n° 7

Sierra Leone

ACF-F 11/02 Nutritional anthropometric survey, Bombali Sebora chiefdom

OCHA 28/02/03 Sierra Leone: humanitarian situation report, February 2003

OCHA 12/03/03 Sierra Leone: Increased refugee movement in eastern border areas

OCHA 03/04/03 Sierra Leone: new refugee camp opened in Kenema

World Bank 26/02/03 Optimism on Sierra Leone

WFP 28/02/03 WFP emergency report n° 9 of 2003

Great Lakes region

OCHA 31/01/03 Affected population in Great Lakes Region as of 31/01/03

UNHCR 23/01/03 Refugees adrift in Africa's Great Lakes region

Burundi

ACF-F 11/02 Evaluation nutritionnelle anthropométrique, province de Kayanza, Burundi

Government of South Africa 30/03/03 Statement on agreement to launch second transitional period in Burundi

MSF 07/02/03 MSF reinforces aid in Burundi as malnutrition increases rapidly

OCHA 02/03/03 Burundi situation report, 24 Feb-2 March 2003

OCHA 30/03/03 Burundi situation report 23-30 March 2003

OCHA 20/04/03 Burundi situation report, 14-20 April 2003

WFP 11/03/03 WFP concerned about food deterioration in Burundi

Democratic Republic of Congo

AAH-USA 10/02 Evaluation nutritionnelle anthropométrique, Baraka, territoire de Fizi, province du Sud Kivu

AAH-USA 11/02 Dépistage nutritionnel dans les aires de santé de Lwanba, Lubinda et Musao, zone de santé de Malemba N'Kulu, Katanga

AAH-USA 11/02 Screening nutritionnel des populations du Inongo, Bandudu

AAH-USA 01/03 Enquête nutritionnelle anthropométrique, ville de Kindu, province de Maniema

AAH-USA 01/03 Evaluation nutritionnelle Kolwezi, zones de santé de Dilala et Manika, Katanga, RDC

HDCHD 02/03 Politics and humanitarianism, coherence in crisis?

MSF of DRC 06/03/03 After Ankoro, MSF opens emergency mission in Kamina Lenge and Mukubu, Katanga region

MONUC and RCD-N 15/01/03 MONUC investigation mission's preliminary report confirms human rights abuses by MLC

OCHA 31/01/03 Affected population in Great Lakes Region as of 31/01/03

OCHA 31/01/03 Humanitarian update - Uganda, volume V, issue 1

PSF 09/02 Rapprot d'évaluation nutritionnelle, zone de santé de Kabinda, Kalonda et Lubao, Kasai Orientale, RDC

SCF-UK 11/02 Household economy analysis of the rural population of south-western Bwito, Rutshuru, north Kivu

SCF-UK 11/02 Update of the household economy analysis of the rural population of the plateaux zone, Masisi, North Kivu

UNHCR 23/01/03 Refugees adrift in Africa's Great Lakes region

UNSC 24/02/03 Report of the UN high commissioner for human rights on DR Congo

WFP 31/01/03 WFP launches emergency airlift to feed 115,000 people in eastern Congo

WFP 07/03/03 WFP emergency report n° 10

Uganda

AAH-USA 02/03 Personal communication

Government of Uganda, UN agencies, NGOs & Pader district authorities 02/03 Assessment of the humanitarian situation of the internally displaced persons in Pader district

IFRC 20/02/03 Uganda: refugees from DRC appeal n° 06/03

OCHA 31/01/03 Humanitarian update - Uganda, volume V, issues 1

OCHA 12/02/03 DRC-Uganda: 12 dead, over 3,000 displaced by ethnic clashes in Nebbi district

OCHA 19/02/03 Uganda: WFP to send food to drought-stricken Karamoja region

OCHA 28/02/03 Uganda: Donors respond to northern Uganda emergency

WFP/MOH 01/03 Nutrition survey among the internally displaced population in Northern Uganda

WFP 28/02/03 WFP emergency report n° 9 of 2003

Southern Africa

Angola

ACH-S 11/02 Inquerito Nutricional, Municipio de Cuito Kuanavale, Provincia de Kuando Kubango

ACH-S 12/02 Inquerito Nutricional e de mortalidade, Municipio de Caconda, Provincia de Huila

ICG 26/02/03 Dealing with Savimbi's ghost: the security and humanitarian challenges in Angola

MOH/UNICEF 20/03/03 Nutrition co-ordination meeting

OCHA 03/02/03 Angola: fiscal transparency to top agenda at donor conference, analysts

OCHA 19/02/03 Humanitarian situation in Angola analysis November-December 2002

RI 07/03/03 Angola: Women's access to demobilisation and reintegration program funding essential

WFP 14/02/03 WFP emergency report n° 7 of 2003

WFP 28/02/03 WFP emergency report n° 9 of 2003

WFP 07/03/03 WFP emergency report n° 10 of 2003

Zambia

UNHCR 10/02 Nutrition status assessment survey in Mwange refugee camp

UNHCR 10/02 Nutrition status assessment survey in Ukwimi refugee camp

UNHCR 10/02 Nutrition status assessment survey in Kala refugee camp

Sahrawi refugees in Algeria

UNHCR/ 09/02 Antropometric and micro-nutrient nutrition survey, Sahrawi refugee camps, Tindouf, WFP/ICH Algeria

Asia selected regions

Afghanistan

AREU 31/12/03 Taking refugees for a ride? The politics of refugee returns to Afghanistan

Government of Pakistan 18/03/03 Pakistan, Afghanistan, UNHCR ink historic agreement on refugees

IOM 28/03/03 IOM press briefing note 28 March 2003: Jordan, Afghanistan

OCHA 15/04/03 Afghanistan: IDPs continue arriving in the south

UNHCR 25/03/03 Afghan refugees face hard choices as old Pakistan camp closes

USAID 13/03/03 Aghanistan complex emergency report # 4

WFP 02/04/03 WFP Aghanistan weekly situation report

WFP/VAM 2002-2003 Afghanistan countrywide food needs assessment of rural settled populations

In brief

Eritrea

OCHA 10/03/03 Humanitarian efforts in Eritrea face funding crisis

OCHA 21/03/03 Eritrea: new warning of hardship as no further funds pledged

WFP 13/03/03 WFP warns food aid supplies running out in Ethiopia and Eritrea

WFP 21/03/03 WFP emergency report n° 12

Ethiopia

FEWS 14/03/03 Ethiopia- monthly food security update

Kenya

Reuters 17/02/03 Kenya bill to help refugees towards self-sufficiency

Tanzania

AFP 21/02/03 UN refugee agency warns food situation in Tanzania camps bad

Abbreviations used in the text
 

Nutritional Assessments

Results of surveys quoted in RNIS # 41
 

*Acute malnutrition (children aged 6-59 months): weight-height < - 2 Z-scores and/or oedema
** Severe acute malnutrition (children aged 6-59 months): weight-height < - 3 Z-scores and/or oedema
*** 95% Confidence Interval; not mentioned if not available from the survey report
# Measles vaccination coverage for children aged 9-59 months

NOTE: see at the end of the report for guidance in interpretation of indicators

*Acute malnutrition (children aged 6-59 months): weight-height < - 2 Z-scores and/or oedema
** Severe acute malnutrition (children aged 6-59 months): weight-height < - 3 Z-scores and/or oedema
*** 95% Confidence Interval; not mentioned if not available from the survey report
# Measles vaccination coverage for children aged 9-59 months
1 Measles vaccination coverage for 12-23 month olds
2 Need to be confirmed

NOTE: see at the end of the report for guidance in interpretation of indicators

Notes on surveys quoted in RNIS # 41

The Greater Horn Region

Somalia

Jeriban district, Mudug region The survey was conducted by UNICEF/MOSA/FSAU in December 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 907 children between 6-59 months. The survey also estimated measles immunisation coverage, vitamin A supplementation coverage, and occurrence of diseases 15 days prior the survey.

Galgodob town, Mudug region The survey was conducted by UNICEF/MOSA/FSAU in December 2002. Using an exhaustive methodology, a total of 1,205 children between 6-59 months were measured. The survey also estimated measles immunisation coverage, vitamin A supplementation coverage, and occurrence of diseases 15 days prior the survey.

Sudan

Bentiu town, Upper Nile The survey was conducted by ACF in collaboration with Care and the Sudanese Red Crescent, in December 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 937 children between 6-59 months. Under-five mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage.

Rob Kona town, Upper Nile The survey was conducted by ACF in collaboration with Care and the Sudanese Red Crescent in December 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 940 children between 6-59 months. Under-five mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage.

Juba town, Eastern Equatoria The survey was conducted by ACF in December 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 981 children between 6-59 months. Under-five mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage.

Juba surroundings, Eastern Equatoria The survey was conducted by ACF in December 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 973 children between 6-59 months. Under-five mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage.

Malakal, Upper Nile The survey was conducted by GOAL in August 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 896 children between 6-59 months. Under-five mortality was estimated retrospectively over the previous 12 months. The survey also estimated vaccination coverage, occurrence of disease 15 days prior to the survey and under-five feeding practices.

IDP camps, Kassala The survey was conducted by GOAL in August 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 886 children between 6-59 months. Under-five mortality was estimated retrospectively over the previous 12 months. The survey also estimated vaccination coverage, occurrence of disease 15 days prior to the survey, under-five feeding practices, water and sanitation status and sources of food.

Panomdit and Chuei payams, Sobat county, Upper Nile The survey was conducted by AAH-USA in January 2003. An exhaustive survey was carried out. The sample only included villages situated within a 4 hours walk from the Payuer airstrip. 542 children between 6-59 months were measured. Under five and crude mortality was estimated retrospectively over the previous four months by the current household census method. The survey also estimated measles vaccination coverage and mothers' nutritional status by measuring MUAC.

West Africa Region

Sierra Leone

Bombali Sebora chiefdom, Bombali district The survey was conducted by ACF-F in November 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 971 children between 6-59 months. The survey also estimated vaccination coverage.

Great Lakes

Democratic Republic of Congo

Kindu town, Maniema province The survey was conducted by AAH-USA in January 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 944 children between 6-59 months. The sample excluded villages which were not accessible for security reasons. The measles vaccination coverage was also estimated for children 9 to 59 months old.

Baraka, Fizzi, South Kivu The survey was conducted by AAH-USA in October 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 934 children between 6-59 months. The sample excluded one area of the town, which was not accessible for security reasons. The measles vaccination coverage was also estimated for children 9 to 59 months old.

Kabinda, Kalonda and Lubao health zone, Kasai Orientale Three surveys were conducted by PSF in September 2002, using a two-stage cluster sampling methodology of 30 clusters. 907 children between 6-59 months were measured in Kabinda, 917 were measured in Kalonda and 935 were measured in Lubao.

Southern Africa

Angola

Caconda municipality, Huila The survey was conducted by ACH-S in December 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 3 months. The survey also estimated measles vaccination coverage and food distribution coverage.

Cuito Kuanavale municipality, Kuando Kubango The survey was conducted by ACH-S in November 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 911 children between 6-59 months. The survey also estimated measles vaccination coverage and food distribution coverage.

Western Sahwari refugees in Algeria

The survey was conducted by ICH/UNHCR/WFP/MOH in September 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 850 children between 6-59 months. The survey also estimated EPI coverage and prevalence of micronutrient deficiencies in infants, children, adolescents and women.

RNIS quarterly reports

The UN Standing Committee on Nutrition, which is the focal point for harmonizing policies in nutrition in the UN system, issues these reports on the nutrition of refugees and displaced people with the intention of raising awareness and facilitating action to improve the situation. This system was started on the recommendation of the SCN's working group on Nutrition of Refugees and Displaced People, by the SCN in February 1993. Based on suggestions made by the working group and the results of a survey of RNIS readers, the Reports on the Nutrition Situation of Refugees and Displaced People are published every three months.

The reports are designed to provide information over time on key outcome indicators from emergency affected populations, play an advocacy role in bringing to the attention of donors and humanitarian agencies the plight of emergency affected populations, and identify recurrent problems in international response capacity.

Information is obtained from a wide range of collaborating agencies, both UN and NGO. RNIS reports put together primarily from agency technical reports on nutrition, mortality rates, health and food security, in refugee and displaced populations.

RNIS reports are organised by "situation" because problems often cross national boundaries. We aim to cover internally displaced populations as well as refugees. Partly this is because the system is aimed at the most nutritionally vulnerable people in the world -- those forced to migrate -- and the problems of those displaced may be similar whether or not they cross national boundaries.

The reports provide a brief summary on the background of a given situation, including who is involved, why people are displaced and what their general situation is. This is followed by details on humanitarian situation, with focus on public nutrition and mortality rates. At the end of most of the situation descriptions, there is a section entitled "Recommendations and Priorities", which is intended to highlight the most pressing humanitarian needs. The recommendations are often put forward by agencies or individuals directly involved in assessments or humanitarian response programmes in the specific areas.

The key point of the reports is to interpret anthropometric data and to judge the various risks and threats to nutrition in both the long and short term.

Indicators, interpretation and classification

Nutrition and mortality survey methodologies and analysis are checked for compliance with internationally agreed standards (SMART, 2002; MSF, 2002; ACF, 2002 ).

Most of the surveys included in the RNIS reports are random sampled surveys, which are representative of the targeted area's population. RNIS may also report on rapid nutrition assessment results, which are not representative of the target population but rather give a rough idea of the nutrition situation. In that case, the limitations of this type of assessment are mentioned.

Most of the nutrition survey results included in the RNIS reports targets 6-59 months old children. If other age groups are included in a survey, RNIS may also report on these results. Detailed information on the surveys used in each RNIS issue is to be found at the back of the publication.

Nutrition indicators in 6-59 month olds

Unless specified, the RNIS reports use the following internationally agreed criteria:

• Wasting, defined as weigh-for-height index (w-h) < -2 Z-scores.
• Severe wasting, defined as weigh-for-height index < -3 Z-scores.
• Oedematous malnutrition or kwashiorkor, diagnosed as bilateral pitting oedema, usually on the upper sur- face of the feet. Oedematous malnutrition is always considered as severe malnutrition.
• Acute malnutrition, defined as the prevalence of wasting (w-h < -2 Z-scores) and/or oedema
• Severe acute malnutrition, defined as the prevalence of severe wasting (w-h < -3 Z-scores) and/or oe- dema.
• Stunting is usually not reported, but when it is, these definitions are used: stunting is defined as < - 2 Z-scores height-for-age, severe stunting is defined < - 3 Z-scores height-for-age.
• Mid-Upper-Arm Circumference (MUAC) is sometimes used to quickly assess nutrition situations. As there is no international agreement on MUAC cut-offs, RNIS reports the results according to the cut- offs used in the survey.
• Micro-nutrient deficiencies Mico-nutritient deficiencies are reported when data are available.

Nutrition indicators in adults

No international consensus on a definitive method or cut-off to assess adult under-nutrition has been reached (SCN, 2000). Different indicators, such as Body Mass Index (BMI, weight/height2), MUAC and oedema, as well as different cut-offs are used. When reporting on adult malnutrition, the RNIS always mentions indicators and cut-offs used by the agency providing the survey.

Mortality rates

In emergency situations, crude mortality rates and under-five mortality rates are usually expressed as number of deaths/10,000 people/day.

Nutrition causal analysis

The RNIS reports have a strong public nutrition focus, which assumes that nutritional status is a result of a variety of interrelated physiological, socio-economic and public health factors (see figure). As far as pos- sible, nutrition situations are interpreted in line with potential underlying determinants of malnutrition.

Interpretation of indicators

Nutrition prevalence and mortality rates are late indicators of a crisis. Low levels of malnutrition or mortal- ity will not indicate if there is an impending crisis. Contextual analysis of health, hygiene, water availability, food security, and access to the populations, is used to interpret nutrition prevalence and mortality rates. Thresholds have been proposed to guide interpretation of anthropometric and mortality results.

A prevalence of acute malnutrition between 5-8% indicates a worrying nutritional situation, and a preva- lence greater than 10% corresponds to a serious nutrition situation (SCN, 1995). The Crude Mortality Rate and under-five mortality rate trigger levels for alert are set at 1/10,000/day and 2/10,000/day respec- tively. CMR and under-five mortality levels of 2/10,000/day and 4/10,000/day respectively indicate a se- vere situation (SCN, 1995).

Those thresholds have to be used with caution and in relation with contextual analysis. Trend analysis is also recommended to follow a situation: if nutrition and/or mortality indicators are deteriorating over time, even if not above threshold, this indicates a worsening situation.

Classification of situations

In the RNIS reports, situations are classed into five categories relating to risk and/or prevalence of mal- nutrition.

The prevalence/risk is indirectly affected by both the underlying causes of malnutrition, relating to food, health and care, and the constraints limiting humanitarian response. These categories are summations of the causes of malnutrition and the humanitarian response:

• Populations in category I -the population is currently in a critical situation; they either have a very high risk of malnutrition or surveys have reported a very high prevalence of malnutrition and/or elevated mortality rates.
• Populations in category II are currently at high risk of becoming malnourished or have a high prevalence of malnutrition.
• Populations in category III are at moderate risk of malnutrition or have a moderately high prevalence of malnutrition; there maybe pockets of high malnutrition in a given area.
• Populations in category IV are not at elevated nutritional risk.
• The risk of malnutrition among populations in category V is not known.

References

Action contre la Faim (2002) Assessment and treatment of malnutrition in emergency situation. Paris: Action contre la Faim.

Médecins sans Frontières (1995) Nutritional guidelines. Paris: Médecins sans Frontières

SCN (2000) Adults, assessment of nutritional status in emergency affected population. Geneva: SCN.

University of Nairobi (1995) Report of a workshop on the improvement of the nutrition of refugees and displaced people in Africa. Geneva: SCN.

SMART (2002) www.smartindicators.org 

Young (1998) Food security assessment in emergencies, theory and practice of a livelihoods approach