United Nations System
Standing Committee on Nutrition

Listing of sources
Abbreviations used in the text
Nutritional Assessments
Notes on surveys quoted in RNIS # 40
Indicators and classification

Listing of sources

Abbreviations used in the text

Nutritional Assessments

Results of surveys quoted in RNIS # 40

click on the graphic below to see the full table

Notes on surveys quoted in RNIS # 40

Greater Horn of Africa

Eritrea

Northern and Southern Red Sea Regions The sur- veys were conducted by MOH/DIA in August 2002. Two-stage cluster sampling methodologies of 30 clus- ters were used to measure 889 children between 6-59 months in urban areas and 916 children in rural areas.

Anseba Region, Asmat, Hagaz and Habero sub-zones The survey was conducted by Concern in Novem- ber 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 1271 children between 6-59 months. The survey also estimated measles immu- nisation coverage, and various food security indicators.

Ethiopia

East Haraghe, Golo Oda & Meyu Muluke woreda The survey was conducted by SCF-UK in October 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 902 children between 6- 59 months. The survey also estimated measles immuni- sation coverage, crude and under-five mortality and a variety of food security indicators.

Dessie Zuria Woreda, South Wollo, Amhara Region The survey was conducted by CONCERN in De- cember 2002. A two-stage cluster sampling methodol- ogy of 30 clusters was used to measure 905 children between 6-59 months. The survey also estimated crude and under-five mortality within the past two months, occurrence of diseases 15 days prior the survey and a variety of food security indicators.

Kalu Woreda, South Wollo, Amhara Region The sur- vey was conducted by CONCERN in November 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 909 children between 6-59 months. The survey also estimated crude and under- five mortality within the past two months, occurrence of diseases 15 days prior the survey and a variety of food security indicators.

Kenya

Kakuma refugee camp The survey was conducted by IRC in September 2002. A two-stage cluster sam- pling methodology of 30 clusters was used to measure 742 children between 6-59 months. The survey also estimated household food consumption the day prior to the survey, immunisation coverage, vitamin A supple- mentation coverage, occurrence of diseases 15 days prior to the survey, under-five feeding practices, hy- giene practices and attendance at feeding programme.

Ifo, Dgahaley and Hagadera refugee camps (Dadabb area) The survey was conducted by MSF-B in June 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 912 children between 6- 59 months.

Somalia

Belet Hawa district, Gedo region The survey was conducted by FSAU/GHC/CARE in October 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 712 children between 6-59 months. The survey also estimated sources of food and income, coping strategies, water sources and medical assistance.

Sudan

Old Fangak district, Phou state The survey was con- ducted by ACF-USA in September 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. 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.

Eritrean refugee camps, Eastern Sudan Five surveys were carried out by UNHCR and COR in August 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.

West Africa Region

Sierra Leone

Refugee camps, Bo, Pujehun and Moyamba districts Six surveys were conducted by ACF in August 2002. When the population camp was less than 5000, exhaustive surveys were carried out, otherwise systematic sampling methodology was used (see table). Crude mortality, un- der-five mortality and measles vacci- nation coverage were also estimated.

Guinea

Guekedou prefecture The survey was conducted by ACH-S in September 2002. A two-stage cluster sampling methodology of 30 clusters was used to meas- ure 1018 children between 6-59 months. The measles vaccination coverage was also estimated for children 9 to 59 months old.

Liberia

IDP camps in Montserrado and Bong county The sur- vey was conducted by IRC in July 2002. Five camps were surveyed in Montserrado county and six camps were surveyed in Bong county. A systematic sampling methodology was used. The sampling interval was one in ten houses. 756 children were measured in Montser- rado county and 348 children were measured in Bong county.

Great Lakes

Tanzania

Refugee camps in Kbondo, Ksulu, Kigoma rural and Ngara districts Eleven surveys were conducted by UNHCR in July 2002. Cluster sam- pling methodology of 30 clusters was used in each camp (see table).

Southern Africa

Angola

Cumbulo quatering and family area, Xa-Mutabe mu- nicipality, Luanda Norte province The survey was conducted by MSF-H in October 2002. An exhaustive survey was carried out; 558 children between 6-59 months were measured. Under five mortality rate was estimated retrospectively over the previous month.

Mavinga town, Cuando Cubango province The sur- vey was conducted by MSF-CH/Epicentre in November 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 1208 children between 6- 59 months. Crude and under five mortality was esti- mated retrospectively over the previous 6 months. The survey also estimated measles vaccination coverage.

Matungo and Capembe quatering and family areas, Cuando Cubango province The survey was conducted by MSF-CH/Epicentre in No- vember 2002. A two-stage cluster sampling methodol- ogy of 30 clusters was used to measure 1172 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 6 months. The survey also estimated measles vaccination 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 esti- mated EPI coverage and prevalence of micronutrient deficiencies in infants, children, adolescents and women.

Afghanistan area

Afghanistan

Displaced camps, Spin Boldak district, Kandahar province MSF-H conducted the survey in five IDP camps in September 2002. A two-stage cluster sam- pling methodology of 30 clusters was used. The survey also estimated measles vaccination coverage.

Mazar city, Balkh province The survey was con- ducted by ACF-F in September 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 949 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 vac- cination coverage, iodine and vitamin A deficiencies and iodized salt consumption.

Sang Sharak district, Sar e Pul province The sur- vey was conducted by ACF-F in September 2002. A two-stage cluster sampling methodology of 30 clusters was used to measure 945 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 3 months by the cur- rent household census method. The survey also esti- mated measles vaccination coverage, iodine and vitamin A deficiencies and iodized salt consumption.

Northern Shamali plain, southern Pansheer The sur- vey was conducted by ACF-F in August 2002. A two- stage cluster sampling methodology of 30 clusters was used to measure 957 children between 6-59 months. Crude and under five mortality was estimated retro- spectively over the previous 3 months by the current household census method. The survey also estimated measles vaccination coverage, iodine and vitamin A defi- ciencies and iodized salt consumption.

Pakistan

Lando Karez refugee camp, Chaman area, Pakistan The survey was conducted by MSF-H in July 2002. A two-stage cluster sampling methodology of 30 clusters was used.

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 recom- mendation of the SCN's working group on Nutrition of Refugees and Displaced People, by the SCN in Feb- ruary 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 af- fected 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 ca- pacity.

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 situa- tion, 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 press- ing humanitarian needs. The recommendations are often put forward by agencies or individuals directly in- volved 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: Ac- tion 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 dis- placed people in Africa. Geneva: SCN.

SMART (2002) www.smartindicators.org

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