NUTRITIONAL ASSESSMENTS

RESULTS OF SURVEYS QUOTED IN OCTOBER 2002 RNIS # 39

Survey Area	Population	Survey conducted by	Date	% Acute Malnutrition* (95% CI)**	% Severe Acute Malnutrition* (95% CI)**	% Oedema	Crude Mortality (/10,000/day) (95% CI)**	Under 5 Mortality (/10,000/day) (95% CI)**	Measles immunisation coverage (%)# (95% CI)**
									Proved by card	Card + history
THE GREATER HORN OF AFRICA
ETHIOPIA
Zone 3, Afar region, Ethiopia	Pastoral (urban excluded)	GOAL	08-02	17.9 (15.5-20.6)	2.9 (1.9-4.3)	0.1	0.66	3.19	0.5	17.6
SOMALIA
Beledweyne district, Hiran region	Resident, IDPs	UNICEF/ IMC/FSAU/	05-02	21.0 (18.4-23.8)	2.7 (1.7-4)	-	-	-	-	52.5
Berdaale district, Bay region	Residents	IMC/FSAU/ UNICEF	05-02	17.1 (14.8-19.8)	3.5 (2.5-5.0)	0.9	-	-	-	54.6
Sahil region, Somaliland	Residents, returnees/ IDP	FSAU7MOH L/UNICEF	05-02	11.8 (9.8-14.1)	2 (1.2-3.2)	0.4	-	-	-	75.3
Sanag region, Somaliland	Residents/ IDP	UNICEF	05-02	13.7	5	3.3	-	-	-	-
SUDAN
Bentiu town, Unity State	Residents, IDPs	ACF/Care/ Sudanese Red Crescen	07-02	21.1 (17.4-25.3)	2.7 (1.4-4.8)	-	-	1.07	56.4	71.1
Rob Kona town, Unity State,	Residents, IDPs	ACF/Care/ Sudanese Red Crescent	07-02	23.4(19.6-27.8)	3.3(1.9-5.6)	-	-	0.69	46.1	69.4
Attar district, Phou state, Upper Nile	Residents, displaced	AHA-USA	04-02	31.0 (26.7-35.6)	6.2 (4.2-9.0)	0.8	3.5	6.0	0.7	8.0
Mareang district, Phou state, Upper Nile	Residents, displaced	AHA-USA	05-02	23.1 (19.1-27.7)	4.7 (2.9-7.5)	0.2	6.7	9.2	-	1.0
Old Fangak district, Phou state, Upper Nile	Residents, displaced	AHA-USA	04-02	30.3 (26.0-34.9)	5.7 (3.8-8.4)	0.9	1.1	2.2	-	0.5
Nyal district, Leech state, Upper Nile	Residents, displaced	AHA-USA	02-02	16.4 (12.9-20.1)	1.6 (0.5-3.1)	0.2	0.41	0.69	-	-
Lankien and Pultruk parishes, Nyirol district, Bieh State, Jonglei	Residents, displaced	AHA-USA	07-02	28.4 (24.3-33.0)	4.3 (2.7-6.8)	0.8	7.2	15.0	-	14.8
Padak, Bor district, Jonglei	Residents, displace	AHA-USA	05-02	37.7 (33.1-42.4)	6.6 (4.5-9.4)	0.6	0.6	1.7	42.1	81.2
Eritrean refugee camps
Girba	Refugees	UNHCR/COR	03-02	10.2 (8.3-12.6)	1.2 (0.6-2.3)	-	-	-	-	-
Kilo 26	Refugees	UNHCR/COR	03-02	9.8 (8.0-12.0)	0.8 (0.3-1.7)	-	-	-	-	-
Wad Sherifey	Refugees	UNHCR/COR	03-02	10.2 (8.3-12.4)	0.7 (0.3-1.5)	-	-	-	-	-
Karkora	Refugees	UNHCR/COR	03-02	12.9 (10.8-15.3)	0.7 (0.3-1.5)	-	-	-	-	-
Abuda	Refugees	UNHCR/COR	03-02	9.5	0.7	-	-	-	-	-
Fau 5	Refugees	UNHCR/COR	03-02	9	0.7	-	-	-	-	-
Wad Hileaw	Refugees	UNHCR/COR	03-02	10.2	2.2	-	-	-	-	-
Shagarab	Refugees	UNHCR/COR	03-02	15.8 (13.5-18.4)	1.3 (0.7-2.4)	-	-	-	-	-
Suki	Refugees	UNHCR/COR	03-02	11.3	1.8	-	-	-	-	-
Aburakham	Refugees	UNHCR/COR	03-02	7.5	0.3	-	-	-	-	-
UmAli	Refugees	UNHCR/COR	03-02	5.4	0	-	-	-	-	-
Hawata	Refugees	UNHCR/COR	03-02	13.2	0.94	-	-	-	-	-
Mafaza	Refugees	UNHCR/COR	03-02	5.8	1.2	-	-	-	-	-
UmSagata	Refugees	UNHCR/COR	03-02	10.4 (8.6-12.7)	1.4 (0.8-2.5)	-	-	-	-	-
WEST AFRICA
SIERRA LEONE
Tonkolili District	Residents + returnees	AcF France	02-02	5.6 (3.7-8.3)	0.6 (0.1-2.0)	0.1	-	-	27.5	66.9
GUINEA
Macentas, prefecture	Resident refugees, IDPs	Action contra la Hambre	03-02	8.4 (6.2-11.4)	0.9 (0.3-2.3)	0.1	1.4	1.4	37.8	74.5
THE GREAT LAKES REGION
UGANDA
Rhinocamp, Arua district	Sudanese refugees	DDHS Arua	05-02	5.6 (3.7-9.3)	0.1 (0-2.4)	0	-	-	63.4	79.6
Impevi refugee sttles ments, Arua district	Sudanese refugee	DDHS Arua	06-02	9	0.9	0.4	-	-	64	78
SOUTHERN AFRICAN REGION
ANGOLA
Chicala, quatering and f amily area, Luena, Moxico province	UNITA demobilised soldiers and families	MSF-B/ MINSA7 GOAL	06-02	17.2 (14.4-20)	2.5 (0.1-4.1)	0.2	3.0 (2.4-3.5)a	6.8 (4.9-8.7)a	53 (45.4-60.6)	69.2
							4.6 (3.6-5.7) b	10.6 (6.7-14.4)b
							1.6 (1.0-2.3)c	4.0 (2.4-5.5) c
Muacanhica, and Muahimbo camps transit centre, Luena, Moxico province	Internal Displaced People	MSF-B/ MINSA7 GOAL	06-02	9.4 (5.4-13.4)	1.4 (0.5-2.3)	0.2	3.6 (2.7-4.6)a	6.0 (4.5-7.6)a	60.8 (54.1-67.4)	82.3
							7.2 (5.3-9.1) b	9.4 (5.3-13.3)b
							2.9 (2.1-3.7)c	5.4 (3.7-7.1)c
ASIA
AFGHANISTAN
Qaisar and Almar districts, Fayab province	residents	MSF-B	07-02	6.3 (4.4-8.1)	1.3 (0.5-2.1)	0.5	1.5 (1.0-2.0)	4 (2.4-5.6)	9.2 (3.9-14.6)	78.4 (69.6-87.3)
Kabul city	Residents, IDPs, returnees	ACF-F	08-02	11.7 (9.9-15.1)	1.6 (0.7-3.3)	-	0.21	0.47	30.4	86.3

*wt/ht unless specified; cut-off = n.s. means not specified but usually 2z scores wt/ht for wasting and 3z scores for severe wasting; Oedema is included in this figure

** If not mentioned, because not available from the survey report # Measles vaccination coverage for children aged 9-59 months

a Deaths recorded from 22-02-2002 to 26-06-2002

b Deaths recorded from 22-02-2002 to 17-04-2002 or to the date of arrival in the camps, corresponding to the period prior their arrival at the quartering and family areas or camps

c Deaths recorded from 18-08-2002 to 26-06-2002, corresponding to the period after their arrival at the quartering and family areas or camps

NOTE: see box on back cover for guidance in interpretation of indicators.

The Greater Horn Region

Ethiopia

AFAR, Zone 3 The survey was conducted by GOAL in August 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The survey also estimated measles immunisation coverage, crude and under-five mortality within the past 3 months, occurrence of diseases 15 days prior the survey, coverage of relief food and a variety of food security indicators.

AFAR, Zone 1 An exhaustive survey was conducted by AcF in 7 villages in 2 Kebele (Alasebolo and Gehertuna Hamitole kebele), which were previously reported to be the most affected in the zone.

Somalia

Beletweyne district, Hiran region The survey was conducted by UNICEF/FSAU/IMC/SRCS in May 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 905 children between 6-59 months. The survey also estimated measles immunisation coverage, vitamin A supplementation coverage, occurrence of diseases 15 days prior the survey, origin of the family, female headed household, food economy group, under-five feeding practices, sources of food and income, water and sanitation status and main source of medical treatment.

Berdaale district, Bay region The survey was conducted by UNICEF/FSAU/IMC in May 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 immunisation coverage, vitamin A supplementation coverage, occurrence of diseases 15 days prior the survey, origin of the family, under-five feeding practices, sources of food and income, coping strategies, water and sanitation status and main source of medical treatment.

Sahil region, Somaliland The survey was conducted by/FSAU/MOHL/UNICEF in May 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 906 children between 6-59 months. The survey also estimated measles immunisation coverage, vitamin A supplementation coverage, occurrence of diseases 15 days prior the survey, origin of the family, under-five feeding practices, sources of food and income, coping strategies, water and sanitation status and main source of medical treatment.

Sanag region The survey was conducted by UNICEF in May 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The survey also estimated measles immunisation coverage, vitamin A supplementation coverage, occurrence of diseases 15 days prior the survey, sources of food and income, coping strategies, water and sanitation status and main source of medical treatment.

Sudan

Bentiu town The survey was conducted by ACF in collaboration with Care and the Sudanese Red Crescent, in July 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 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 The survey was conducted by ACF in collaboration with Care and the Sudanese Red Crescent in July 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 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.

Nyal district, Leech state The survey was conducted by ACF-USA in February 2002. A two-stage cluster sampling methodology of 30 clusters was used. The sample only included villages of more than 20 households and situated within a 4 hours walk from the centre of the parish. 900 children between 6-59 months were measured. Under five and crude mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage and mother’s nutritional status by measuring MUAC.

Old Fangak district, Phou state The survey was conducted by ACF-USA in April 2002. A two-stage cluster sampling methodology of 30 clusters was used. The sample only included villages situated within a 4 hours walk from the centre of the parish. 899 children between 6-59 months were measured. Under five and crude mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage and mother’s nutritional status by measuring MUAC.

Atar district, Phou state The survey was conducted by ACF-USA in April 2002. A two-stage cluster sampling methodology of 30 clusters was used. The sample only included villages situated within a 4 hours walk from the centre of the parish. 899 children between 6-59 months were measured. Under five and crude mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage and mother’s nutritional status by measuring MUAC.

Mareang district, Phou state The survey was conducted by ACF-USA in May 2002. A two-stage cluster sampling methodology of 30 clusters was used. The sample only included villages situated within a 4 hours walk from the centre of the parish. 805 children between 6-59 months were measured. Under five and crude mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage and mother’s nutritional status by measuring MUAC.

Padak (Athoac region), South Bor County The survey was conducted by ACF-USA in May 2002. A two-stage cluster sampling methodology of 30 clusters was used. 900 children between 6-59 months were measured. Under five and crude mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage and mother’s nutritional status by measuring MUAC.

Lankien and Pultruk parishes, Nyirol district, Bieh state The survey was conducted by ACF-USA in July 2002. A two-stage cluster sampling methodology of 30 clusters was used. The sample only included villages situated within a 3 and ½ hours walk from Lankien. 899 children between 6-59 months were measured. Under five and crude mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles vaccination coverage and mother’s nutritional status by measuring MUAC.

Eritrean refugee camps, Eastern Sudan Fourteen surveys were carried our by UNHCR and COR in March 2002. When the population camp was less than 5000, exhaustive surveys were carried out, otherwise cluster sampling methodology of 30 clusters was used (see table). EPI coverage and vitamin A coverage were also estimated.

Camp	Type of sample	Sample size
Girba	Cluster	811
Kilo 26	Cluster	900
Wad Sherifey	Cluster	896
Karkora	Cluster	900
Abuda	Exhaustive	273
Fau 5	Exhaustive	155
Wad Hileaw	Exhaustive	186
Shagarab	Cluster	900
Suki	Exhaustive	222
Aburakham	Exhaustive	308
UmAli	Exhaustive	111
Hawata	Exhaustive	213
Mafaza	Exhaustive	87
UmSagata	Cluster	900

West Africa Region

Sierra Leone

Tonkolili district The survey was conducted by AcF in February 2002. A two-stage cluster sampling methodology of 30 clusters of 30 children was used to measure 900 children between 6-59 months. The measles vaccination coverage was also estimated for children 9 to 59 months old.

Kenema district The survey was conducted by HAI in February 200 on older people in Ningowa chiefdom. This survey is not representative of the general status elderly as 200 older people were selected because of their vulnerability defined by fulfilling at least one of the following criteria: Suffering from severe malnutrition (visible); low physical strength; traumatised; poor health; lacking resources and basic livelihoods; supporting and caring for war-orphans and/or young children; aged above 50 years without a career’; using walking sticks/crutches (immobility); displaced/returnees; rape victims that have had no medical attention; isolated older persons; disabled isolated older persons who have significant threats to their basic needs of health, food, and water.

Guinea

Macenta prefecture The survey was conducted by ACH in March 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 1006 children between 6-59 months. Under five and crude mortality rates were estimated retrospectively over the previous three months by the current household census method. The measles vaccination coverage was also estimated for children 9 to 59 months old.

The Great Lakes region

Uganda

Rhinocamp, Arua district (Sudanese refugee settlements) The survey was conducted by the District Director for Health Services for Arua local government in May 2002. 764 children between 6-59 months were measured. 42 settlements were visited, the number of children measured in each settlement was proportionate to the total number of under-five children in all the 42 settlements. The coverage of measles vaccination was also estimated.

Impevi camp, Arua district (Sudanese refugee settlements) The survey was conducted by the District Director for Health Services for Arua local government in June 2002. An exhaustive survey methodology was used to measure all children between 6-59 months in the setllements.

556 children were surveyed. The coverage of measles vaccination was also estimated.

Palorinya camps, Moyo district (Sudanese refugee settlements) The survey was conducted by African Development and Emergency Organisation (ADEO) in October 2001. A two-stage cluster sampling methodology of 30 clusters was used to measure 900 children between 6-59 months. The coverage of measles vaccination was also estimated.

Angola

Chicala quatering and family area, Luena, Moxico province The survey was conducted by MSF-B/MINSA/GOAL in June 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 593 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 4 months (since Jonas Savimbi death on the 22 of February 2002) by the current household census method. Mortality results were further desagregated to compare mortality rates before and after arrival in the QFA. The coverage of measles vaccination was also estimated.

Muacanhica, Muachimbo camps and transit centre, Luena, Moxico province The survey was conducted by MSF-B/MINSA/GOAL in June 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 637 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 4 months (since Savimbi death on the 22 of February 2002) by the current household census method. Mortality results were further desagregated to compare mortality rates before and after arrival in the camps. The coverage of measles vaccination was also estimated.

Afghanistan area

Afghanistan

Qaisar and Almar district, Faryab province The survey was conducted by MSF-B in July 2002. Some villages were discarded from the sampling frame because of insecurity. A two-stage cluster sampling methodology of 30 clusters was used to measure 911 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 4 months by the current household census method. The survey also estimated measles vaccination coverage and various food security indicators.

Kabul city The survey was conducted by ACF in August 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 954 children between 6-59 months. A sampling methodology of 30 clusters was used to measure 911 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 3 months by the current household census method. The survey also estimated measles vaccination coverage.

Notes Detailed information on the surveys used in each RNIS issue is to be found in an annex at the back of the publication. The data comes from a variety of UN and NGO sources. The table and the figure in which an estimate of the total refugee/displaced/returnee population broken down by risk category, included in previous RNIS issues have been discontinued due to uncertainties about number estimates, particularly for IDPs, and to difficulties in comparing trends, as reports in different RNIS bulletins inevitably often do not cover quite the same situations or over readily comparable time periods. French summaries have been included. The references there are to the tables, graphs and figures included in the English core text. La description détaillée des résultats et de la méthodologie des enquêtes utilisées dans le bulletin sont décrites à la fin de la publication. Les données proviennent de différentes ONG et organisations des Nations Unies. Le tableau et la figure qui, dans les bulletins précédents donnaient une estimation du nombre de personnes par catégorie de risque, ne sont plus mentionnés en raison de l’incertitude des chiffres de population, en particulier pour les personnes déplacées et de la difficulté de comparer des tendances entre les bulletins qui ne couvrent pas forcément exactement les mêmes situations ou les mêmes périodes. Des résumés en français ont été inclus au bulletin, se référant aux tableaux, graphiques et figures inclus dans le texte principal en anglais. Information An inter-agency initiative to improve the monitoring, reporting and evaluation of humanitarian interventions, through nutrition and mortality surveys, has been developed (SMART project). The overall objective is to improve the technical quality of nutrition and mortality data in emergencies through development of standardised survey methodologies and improving the capacity of organisations involved to carry out, analyse, interpret and report on survey findings. More information can be accessed from the Internet at www.smartindicators.org. Une initiative interagence a été développée afin d’améliorer la surveillance, le compte-rendu et l’évaluation des interventions humanitaires à partir des enquêtes nutritionnelles et de mortalité (projet SMART). L’objectif de ce projet est d’améliorer la qualité technique des données nutritionnelles et de mortalité dans les situations d’urgence humanitaire, par le développement d’une méthodologie standardisée et l’amélioration de la capacité des organisations à conduire, analyser et interpréter les enquêtes. Pour plus d’informations, consulter le site: www.smartindicators.org

Map of Africa

Seasonality in Sub-Saharan Africa*

Angola		Coastal area desert, SW semi-arid, rest of country: rains Sept-April
Burundi		Three crop seasons: Sept-Jan, Feb-Jun., and Jul-Aug.
CAR		Rains March-Nov
Djibouti		Arid Climate
Ethiopia		Two rainy seasons February to May and June to October
Kenya		N-E is semi-arid to arid, Central and SW rains: March-May and Nov-Dec.
Liberia		Rains March-Nov
Mozambique		Coast is semi-arid, rest wet-dry. Harvest May
Rwanda		Rains Feb-May with Aug. harvest and Sept-Nov with Jan harvest
Sierra Leone		Rains March-Oct.
Somalia		Two seasons: April to August (harvest) and October to January/February (harvest)
Sudan		Rains April-Oct.
	North	Rains begin May/June
	South	Rains begin March/April
Togo		Two rainy seasons in S, one in N. Harvest August
Uganda		Rains Mar-Oct.
Zaire		Tropical climate. Harvest in N: November; in S January

*SOURCES:

FAO, “Food Supply Situation and Crop Prospects in Sub-Saharan Africa”, Special Report; No 4/5,

The SPHERE Project Conceptual Model of the causes of malnutrition in emergencies (draft, adapted from UNICEF)

Note: the Sphere project is an initiative to improve the quality of humanitarian assistance and to enhance accountability of the humanitarian system, through the production of globally applicable minimum standards. The humanitarian Charter is at the core of the Sphere project it re-affirms what is already known from international humanitarian law and human rights treaties. The charter makes explicit links to the defined levels of service delivery set out in the five core sectors: water supply and sanitation; nutrition; food aid; shelter and site planning; and health services. Together, the Charter and Minimum Standards offer an operational framework for accountability in humanitarian response - a common set of criteria for programme monitoring; a benchmark from which to make some judgement about the effectiveness of work; and, probably most importantly, a benchmark for use in advocacy to enhance levels of services. To obtain more information on the Sphere project at http://www.sphereproject.org or email:sphere@ifrc.org

INDICATORS

WASTING is defined <-2S Z scores wt/ht, or sometimes <80%, wt/ht by NCHS standards, usually in children of 6-59 months. For guidance in interpretation, prevalences of around 5-10% are usual in African populations in non-drought periods. A prevalence > 10% is considered an alert and a prevalence of over 15% is considered serious. A 20% prevalence of wasting is undoubtedly high, although these figures should be interpreted with the context.

SEVERE WASTING can be defined as below -3SDs (or about 70%). Any significant prevalence of severe wasting is unusual and indicates heightened risk. (When “wasting” and “severe wasting” are reported in the text, wasting includes severe -e.g. total percent less than -2SDs, not percent between -2SDs and -3SDs.)

STUNTING is defined as less than 2SDs height-for-age by NCHS standards, usually in children aged 6-59 months.

SEVERE STUNTING is defined as less than 3SDs height-for-age by NCHS standards, usually in children aged 6-59 months. (When “stunting” and “severe stunting” are reported in the text, stunting includes severe -e.g. total percent less than -2SDs, not percent between -2SDs and -3SDs.)

BMI (wt/ht²) is a measure of chronic undernutrition in adults. We have taken BMI<18.5 as an indication of mild chronic undernutrition, and BMI<16 as an indication of severe chronic undernutrition in adults aged less than 60 years (WHO, 1995). The BMI of different populations should not be compared without standardising for body shape. (See July 2000 RNIS supplement on measuring adult nutritional status).

MUAC (cm) is a measure of energy deficiency in both adults and children. In children, equivalent cut-offs to -2SDs and -3SDs of wt/ht for arm circumference are about 12.0 to 12.5 cms, and 11.0 to 11.5 cms. In adults, MUAC<22 cm in women and <23 cm in men may be indicative of a poor nutritional status. BMI and MUAC are sometimes used in conjunction to classify adult nutritional status (James et al, 1994). Acute adult undernutrition may be diagnosed using MUAC. A MUAC<18.5 may be indicative of acute undernutrition and MUAC<16 of severe acute malnutrition. (See July 2000 RNIS supplement on measuring adult nutritional status).

OEDEMA is the key clinical sign of kwashiorkor, a severe form of protein-energy malnutrition, carrying a very high mortality risk in young children. It should be diagnosed as pitting oedema, usually on the upper surface of the foot. Where oedema is noted in the text, it means kwashiorkor. Any prevalence detected is cause for concern.

ACUTE MALNUTRITION is the prevalence of wasting (Weight for Height) <-2 Z scores and/or oedema.

CHRONIC MALNUTRITION is the prevalence of stunting (Height for age)

A CRUDE MORTALITY RATE in a normal population in a developed or developing country is around 10/1,000/year which is equivalent to 0.27/10,000/day (or 8/10,000/month). Mortality rates are given here as “times normal”, i.e. as multiple of 0.27/10,000/day. [CDC has proposed that above 1/10,000/day is a very serious situation and above 2/10,000/day is an emergency out of control.] Under-five mortality rates (U5MR) are increasingly reported. The average U5MR for Sub-Saharan Africa is 175/1,000 live births, equivalent to 1.4/10,000 children/day and for South Asia the U5MR is 0.7/10,000/day (in 1995, see UNICEF, 1997, p.98).

FOOD DISTRIBUTED is usually estimated as dietary energy made available, as an average figure in kcals/person/day. This divides the total food energy distributed by population irrespective of age/gender (kcals being derived from known composition of foods); note that this population estimate is often very uncertain. The adequacy of this average figure can be roughly assessed by comparison with the calculated average requirement for the population (although this ignores maldistribution), itself determined by four parameters: demographic composition, activity level to be supported, body weights of the population, and environmental temperature; an allowance for regaining body weight lost by prior malnutrition is sometimes included (see Schofield and Mason 1994 for more on this subject). For a healthy population with a demographic composition typical of Africa, under normal nutritional conditions, and environmental temperature of 20^oC, the average requirement is estimated as 1,950-2,210 kcals/person/day for light activity (1.55 BMR). Raised mortality is observed to be associated with kcal availability of less than 1,500 kcals/person/day (ACC/SCN, 1994, p81).

INDICATORS AND CUT-OFFS INDICATING SERIOUS PROBLEMS are levels of wasting above 20%, crude mortality rates in excess of 1/10,000/day (about four times normal - especially if still rising), and/or significant levels of micronutrient deficiency disease. Food rations significantly less than the average requirements as described above for a population wholly dependent on food aid would also indicate an emergency.

REFERENCES:

ACC/SCN (1994) Update on the Nutrition Situation, 1994 (p81).James W.P.T. and Schofield C. (1990) Human Energy Requirements. FAO/OUP.

Collins, S., Duffield A., and Myatt, M. 2000 Assessment of adult nutritional status in emergency-affected populations. RNIS supplement.

James, W.P.T., Mascie-Taylor, C.G.N., Norgan, N.G., Bistrian, B.R., Shetty, P.S. and Ferro-Luzzi, A. 1994. The value of MUAC in assessing chronic energy deficiency in Third World Adults. Eur. Jour. Clin. Nut. 48:883-894.

Schofield C. and Mason J. (1994) Evaluating Energy Adequacy of Rations Provided to Refugees and Displaced Persons. Paper prepared for Workshop on the Improvement of the Nutrition of Refugees and Displaced People in Africa, Machakos, Kenya, 5-7 December 1994. ACC/SCN, Geneva.

UNICEF (1997) State of the World’s Children p.98. UNICEF, New York.

WHO (1995) Bulletin of the World Health Organization, 1995, 73 (5): 673-680.