United Nations System
Standing Committee on Nutrition

RNIS 43 - November 2003

Listing of sources
Abbreviations used in the text
Nutritional Assessments
Notes on surveys quoted in RNIS # 43
Indicators and classification

Listing of sources
 

Abbreviations used in the text
 

Nutritional Assessments

Results of surveys quoted in RNIS # 43

Notes on surveys quoted in RNIS # 43

The Greater Horn Region

Eritrea

Asmat, Hagaz and Habero, Anseba The survey was conducted by Concern in March 2003. A two-stage cluster sampling methodology of 46 clusters was used to measure 1324 children between 6-59 months. Under-five and crude mortality was estimated retrospectively over the previous 4 months. The survey also estimated occurrence of diseases 15 days prior the survey and coverage of food aid distribution.

Dekemhare, Mendefera, Dwarwa, Sergheneyti and Azera, Debub The survey was conducted by CRS in June 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 962 children between 6-59 months. The survey also estimated occurrence of diseases 15 days prior to the survey, measles immunisation coverage and coverage of food aid distribution.

Ethiopia

Oromia Rural areas, Zigway, Admitulo, Jido districts, East Showa zone The survey was conducted by MSF-H in October 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 902 children between 6-59 months. Under-five and crude mortality was estimated retrospectively. The survey also estimated occurrence of diseases 15 days prior the survey and coverage of food aid distribution.

SNNPR Offa Woreda, Wolayita zone The survey was conducted by Concern in September 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 905 children between 6-59 months. Under-five and crude mortality was estimated retrospectively. The survey also estimated occurrence of diseases 15 days prior the survey and measles immunisation coverage.

Kenya Ifo, Dagahaley and Hagadera camps (Dadaab), Garissa region The survey was conducted by MSF-B in June 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 897 children between 6-59 months. Under-five and crude mortality was estimated retrospectively over the previous three months. The survey also estimated measles immunisation coverage.

Somalia

Beletweyne district, Hiran The survey was conducted by UNICEF/ FSAU in July 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 901 children between 6-59 months. Under-five and crude mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles immunisation coverage, vitamin A supplementation coverage, occurrence of diseases 15 days prior to the survey and various food security and public health indicators.

IDP/refugees settlements, Bossaso, Bari An exhaustive survey was conducted by UNICEF in August 2003. 1077 children between 6-59 months were measured. The survey also estimated measles immunisation coverage, vitamin A supplementation coverage, occurrence of diseases 15 days prior to the survey and various food security and public health indicators.

Hawd of Togdheer The survey was conducted by FSAU/MOHL/SRCS in August 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 904 children between 6-59 months. Under-five and crude mortality was estimated retrospectively over the previous three months by the current household census method. The survey also estimated measles immunisation coverage, vitamin A supplementation coverage, occurrence of diseases 15 days prior to the survey and various food security and public health indicators.

Sudan

Thiet, Pagol, Warrap and Tonj payams, Tonj county, Bahr el Gazal The survey was conducted by WV, in May 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 911 children between 6-59 months.

Toch and Pathuon payams, Gogrial county, Bahr el Gazal The survey was conducted by WV, in May 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 948 children between 6-59 months.

Maban province, Latjor state, Eastern Equatoria The survey was conducted by AAH-USA in August 2003. The sample only included villages situated within a 4 hours walk from the centre of Bawac. A two-stage cluster sampling methodology of 30 clusters was used to measure 734 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.

Central Africa

Burundi

Karuzi Province The survey was conducted by MSF-B in July 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 924 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.

Democratic Republic of Congo

Oicha and Mutwanga health zones, Beni area, North Kivu The surveys were conducted by WV in June 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 1,223 children between 6-59 months in Oicha health zone and 1,020 children in Mutwanga health zone.

Kabalo health zone, Kalieme area, Katanga The survey was conducted by MSF-S in April 2003. 40% of the health zone was discarded from the sampling frame because of insecurity. A two-stage cluster sampling methodology of 30 clusters was used to measure 928 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

Tanzania

Refugee camps 13 surveys were conducted by UNHCR in August 2003. Cluster sampling methodology of 30 clusters was used in each camp, except in Mkugwa, where an exhausted survey was carried out.

Uganda

Kalongo town, Pader district The survey was conducted by GOAL in August 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 898 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 3 months. The survey also estimated various food security and public health indicators.

Southern Africa

Angola

Ganda municipality, Benguela province The survey was conducted by ACH-S in August 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 958 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.

Caconda and Cusse municipalities, Huila province The survey was conducted by ACH-S in June 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 941 children between 6-59 months. Crude and under five mortality was estimated retrospectively over the previous 3 months. The survey also estimated vaccination coverage among the 12-23 month olds.

Asia selected situations

Afghanistan region Northern Shamali-southern Pansheer (Kohband, Kohistan 1 and 2, Mahmud-e-Raqi districts, Kapisa province. Jabul Sarj, Sayed Khil, Charikar, Anaba and Rokha 2 districts, ¨Parwan province) The survey was conducted by ACF-F in August 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 965 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.

Southern Kapisa (Alasay, Nejrab and Tagab districts) The survey was conducted by ACF-F in August 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 965 children between 6-59 months. The survey also estimated measles vaccination coverage.

Kabul city The survey was conducted by ACF-F in August 2003. 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 by the current household census method. The survey also estimated measles vaccination coverage.

"New" refugee camps, NWFP, Pakistan The survey was conducted by ACF in June 2003. A two-stage cluster sampling methodology of 30 clusters was used to measure 919 children in Basu, Old Bagzai, Ashgaro, Kotki, Bar Kalay, Shelmann, New Shamshatoo camps. Under five mortality was estimated retrospectively over the previous 3 months by the current household census method. The survey also estimated and various food security indicators.

Middle East

Occupied Palestinian Territories West Bank and Gaza Strip, AQU/JHU/Care The survey was conducted from May to July 2002. The sample was a stratified multi-stage random sample. 936 children were measured.

West Bank and Gaza Strip, PCBS survey The survey was conducted in June 2002. The sample was a stratified multi-stage random sample. 5,228 households were included in the sample.

Gaza Strip, AEI/ACH The survey was conducted by ACH in March 2003. A systematic sampling methodology was used to measure 1251 children.

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