Assessment and analysis standard 2: nutrition
Where people are at risk of malnutrition, programme decisions are based on a demonstrated understanding of the causes, type, degree and extent of malnutrition, and the most appropriate response.
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Key indicators (to be read in conjunction with the guidance notes)
Before conducting an anthropometric survey, information on the underlying causes of malnutrition (food, health and care) is analysed and reported, highlighting the nature and severity of the problem(s) and those groups with the greatest nutritional and support needs (see guidance note 1 and General nutrition support standard 2).
The opinions of the community and other local stakeholders on the causes of malnutrition are considered (see guidance note 1).
Anthropometric surveys are conducted only where information and analysis is needed to inform programme decision-making (see guidance note 2).
International anthropometric survey guidelines, and national guidelines consistent with these, are adhered to for determining the type, degree and extent of malnutrition (see guidance note 3).
Where anthropometric surveys are conducted among children under five years, international weight-for-height reference values are used for reporting malnutrition in Z scores and percentage of the median for planning purposes (see guidance note 3).
Micronutrient deficiencies to which the population is at risk are determined (see guidance note 4).
Responses recommended after nutrition assessment build upon and complement local capacities in a coordinated manner.
Guidance notes
1. Underlying causes: the immediate causes of malnutrition are disease and/or inadequate food intake (which in turn result from food insecurity), a poor public health or social and care environment, or inadequate access to health services at household and community levels. These underlying causes are influenced by other basic causes including human, structural, natural and economic resources, the political, cultural and security context, the formal and informal infrastructure, and population movements (forced or unforced) and constraints on movement. An understanding of the causes of malnutrition in each specific context is an essential prerequisite for any nutrition programme. Information on the causes of malnutrition can be gathered from primary or secondary sources, including existing health and nutrition profiles, research reports, early warning information, health centre records, food security reports and community welfare groups, and can comprise both quantitative and qualitative information. A nutrition assessment checklist can be found in Appendix 4.
2. Decision-making should rely on an understanding of all three possible underlying causes of malnutrition as well as results from anthropometric surveys. In an acute crisis, however, decisions to implement general food distribution need not await the results of anthropometric surveys, as these can take up to three weeks. It should, however, be possible to use anthropometric survey findings to inform decisions on responses aimed at correcting malnutrition.
3. Anthropometric surveys provide an estimate of the prevalence of malnutrition. The most widely accepted practice is to assess malnutrition levels in children aged 6-59 months as a proxy for the population as a whole. However, other groups may be affected to a greater extent or face greater nutritional risk. When this is the case, the situation of these groups should be assessed, although measurement can be problematic (see Appendix 5). International guidelines stipulate that a representative sample is used for surveys; adherence to national guidelines can promote coordination and comparability of reporting. Where representative data are available on trends in nutritional status, these are preferable to a single prevalence figure. Immunisation coverage rates can also usefully be gathered during an anthropometric survey, as can retrospective mortality data, using a different sampling frame. Reports should always describe the probable causes of malnutrition, and nutritional oedema should be reported separately.
4. Micronutrient deficiencies: if the population is known to have been vitamin A-, iodine- or iron-deficient prior to the disaster, it can be assumed that this will remain a problem during the disaster. When analysis of the health and food security situations suggests a risk of micronutrient deficiency, steps to improve the quantification of specific deficiencies should be taken (see also General nutrition support standard 1 and Correction of malnutrition standard 3).
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