Nutriton Surveys in Emergencies | Malnutrition

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This document is intended for qualified nutritionists who are new to Oxfam. It describes Oxfam's approach to nutritional surveys, rather than providing detailed guidelines on how to do a nutritional survey. This document should be used in conjunction with Food Scarcity and Famine
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    OXFAM’S APPROACH TO NUTRITION SURVEYS IN EMERGENCIES   Susanne Jaspars and Hisham Khogali Oxfam Food and Nutrition Group. May, 2001    2   2 Table of Contents   1.   Introduction .....................................................................................................................1 2.   Why conduct a nutrition survey? ...................................................................................1 2.1 Objectives of nutrition surveys in emergencies...........................................................1 2.2 When to conduct a nutrition survey.............................................................................1 2.3 Conditions for doing a survey......................................................................................2 3. A public nutrition approach ...................................................................................................2 4. The causes of malnutrition ....................................................................................................5 4.1 The immediate causes of malnutrition.........................................................................5 4.2 Underlying causes of malnutrition...............................................................................5 4.3 Basic causes of malnutrition........................................................................................6 5. What to assess. ......................................................................................................................7 5.1 Anthropometry.............................................................................................................7 5.2 Morbidity and mortality................................................................................................8 5.3 Food security...............................................................................................................8 5.4 The social and care environment................................................................................9 5.5 The health environment...............................................................................................9 5.6 Available resources.....................................................................................................9 5.7 Political and security context.....................................................................................10 6.   Nutritional survey methods ..........................................................................................10 6.1 Organisation of surveys; teams and training.............................................................10 6.2 Anthropometry...........................................................................................................10 6.2 Morbidity and mortality..............................................................................................12 6.3 Underlying causes.....................................................................................................13 7.   Analysis ..........................................................................................................................14 7.1 Anthropometry...........................................................................................................14 7.2 Mortality.....................................................................................................................15 7.3 Determining whether the nutritional situation is unusually severe.............................15 7.4 Recommending appropriate interventions.................................................................16 8. Report writing ................................................................................................................18 8.1 Preliminary reports....................................................................................................18 8.2 Report structure and contents...................................................................................18 Sources ......................................................................................................................................20 Annex 1 - sources of bias in nutrition surveys ......................................................................21 Annex 2 – Nutrition Survey form ...............................................................................................22    3   3 Annex 3 – An example of seasonal trends in the prevalence of malnutrition. ....................23 Annex 4 - selection of rapid appraisal techniques useful in food security assessments .23 Annex 5 – Examples of key informant checklists to assess underlying causes of malnutrition ........................................................................................................................................24 Annex 6 – Example of results of a proportional piling exercise to determine shifts in main sources of food. From surveys in Turkana, Kenya, 2000. .......................................26 Annex 7 – Example of frequency distribution curve ..............................................................27 Annex 8- Decision making framework for the implementation of feeding programmes ....28  1. Introduction This document is intended for qualified nutritionists who are new to Oxfam. It describes Oxfam’s approach to nutritional surveys, rather than providing detailed guidelines on how to do a nutritional survey. This document should be used in conjunction with “Food Scarcity and Famine; Assessment and Response”. (Young, 1992), and the MSF Nutrition Guidelines (MSF, 1995). Sampling and anthropometry is not covered in detail in this document. For sampling and how to weigh and measure children, the following text is recommended:: ! MSF Guidelines, page 41-48 for information on weighing and measuring children and explanation of different anthropometric indices. ! MSF Guidelines pages 49-59 for sampling methods. ! Food Scarcity and Famine;…Appendix 3 for explanation of how to do cluster sampling. ! Food Scarcity and Famine… Appendix 4, for nutrition survey statistics. In addition, “Food Scarcity and Famine;..” is recommended for information on qualitative methods to gather information on nutrition (pages 17-32), and for practical information on organising surveys (pages 33-39). Oxfam has Food and Nutrition Advisors based in Oxford, whose role is to provide technical support to nutritionists in the field, and to country offices and Humanitarian Co-ordinators who are planning or implementing food and nutrition programmes. If in doubt about any aspect of a nutritional survey, always  seek technical advice from a Food and Nutrition Advisor in Oxfam House. 2. Why conduct a nutrition survey? 2.1 Objectives of nutrition surveys in emergencies There are four main reasons why Oxfam may want to do a nutritional survey ! To determine the severity of people’s nutritional situation and the risk to people’s lives. ! To identify appropriate interventions to address malnutrition and its underlying causes. ! To evaluate programmes; i.e. to provide a baseline from which to evaluate nutrition programmes. !  Advocacy; to highlight a nutritional problem and elicit a response. Some agencies limit the objectives of a nutritional survey to estimating the prevalence of malnutrition to establish a baseline, and to assess the need for therapeutic and supplementary feeding programmes. Oxfam aims to identify any intervention that addresses malnutrition, not just feeding programmes. 2.2 When to conduct a nutrition survey In most emergency situations, there is already some information indicating the risk of malnutrition. Oxfam may already have conducted a rapid assessment (using the Public Health Assessment Tool), which shows the need for an emergency intervention. Government, local authorities, or UN may have requested NGOs to respond. Humanitarian agencies usually conduct nutritional surveys when they expect the need for an emergency response. Generally, Oxfam does a survey when; 2.2.1 Available information is insufficient for decision making on emergency response Information on the risks to nutrition may be sufficient to start an immediate life-saving response, without first conducting a nutritional survey 1 . If an analysis of available information on access to food and health risks indicates a severe nutritional crisis, an immediate response is required. In this case, Oxfam starts a life-saving intervention before doing a survey. A survey is done as soon as possible, to monitor the impact of the programme and to identify the underlying causes of malnutrition. 1   Note that Sphere nutrition analysis standard 1 (assessment) recommends an initial assessment before programme decisions are made. The initial assessment should include information on conditions which may create a risk of malnutrition, but this need not be a nutritional survey.
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