Why measure malnutrition in emergencies?

During a nutritional emergency, the relief foods may be scarce and should be given to the people in greatest need.  Since much of a population may be able to supply part or all of its own food, it is very useful to have an objective and quantifiable measure of nutritional status.

The most common reasons for measuring malnutrition in a relief program are:

-        Initial assessment: A rapid survey of the population should be done before initiating a relief program, in order to identify the areas or groups that are most affected. 

-        Individual screening – Body measurements (anthropometry), particularly height, weight, and arm circumference, may be used as a measure of nutritional status to select the malnourished individuals eligible for food relief for themselves or their whole family.  Valuable information may also be obtained from simpler methods, for example, monitoring clinic records or measuring the prevalence of edema.

-        Nutritional surveillance of the population.  The repeated measuring of entire communities gives an idea of differences among the various population groups and changes in nutritional status with time.  It may be used to decide priorities in the distribution of relief and can also provide some information about the effectiveness of the relief program. 

The initial assessment is always meant to be rapid, as it must be performed in limited time, during or in the immediate aftermath of an emergency.  At the onset of a crisis, rapid assessment information is used to recognize and quantify the emergency, and to readjust strategies and plans accordingly.  Once a program of assistance is under way, periodic assessments are done to assist evaluation of the effectiveness of response and recovery.

Specifically, the purpose of a nutritional assessment is to:

-        Establish that a nutritional emergency or the risk of a nutritional emergency exists

-        Identify the main causes of the emergency, estimate its severity and geographical extent

-        Assess its likely evolution and impact on health and nutritional state

-        Identify the areas and the socioeconomic groups most affected or at risk

-        Assess existing response capacity and identify the most effective measures to prevent or minimize the nutritional emergency; and

-        Establish or expand existing surveillance, so that the effectiveness of measures taken can be monitored over time.

Types of Assessments

Assessment Teams collect two types of information: what has happened as a result of the disaster and what is needed. The type of information that is usually available first to an Assessment Team concerns the effects of the disaster. Collecting this information is referred to as a situation or disaster assessment. It identifies the magnitude and extent of the disaster and its effects on the society. The other information gathered is a needs assessment. It defines the level and type of assistance required for the affected population. The gathering of information for the situation assessment and needs assessment can be done concurrently. The information collected in the initial assessment is the basis for determining the type and amount of relief needed during the immediate response phase of the disaster. It may also identify the need for continued monitoring and reassessing of the unfolding disaster.

The objective or purpose of an assessment survey should be clearly determined before the start.  Those surveyed are usually preschool children.  In a very rapid assessment of nutritional status in emergencies, the only indicator used is weight for height (the presence or absence of edema should be noted as edema adds to a child’s weight and so might confound the results).

Information on nutritional status will be of practical use only within the framework of the general situation in the country or region in which the emergency occurs.  Existing knowledge on demography, mortality and morbidity, previous nutritional status, the socioeconomic situation, administrative structure, communications, etc. should be collected before embarking on a rapid assessment of nutritional status. 

The population to be assessed may be moving or living in camps, towns or villages, or dispersed in a rural environment.  This will have important bearings on the design of the survey and the use of the results.