5.3 Trends in Assessment Methodologies
This section will briefly review the use of anthropometric surveys and food security assessments in displacement emergencies. Other early warning systems will also be discussed.
Anthropometric measurements of children aged 6 - 59 months are the most widely used indicators of the nutritional status of emergency-affected populations. The results of anthropometric surveys continue to be valued by decision-makers. This is because the anthropometric status of population groups is very sensitive to changes in access to food, health services, and caring practices and also because reliable data on anthropometric status are robust and are available in the majority of emergency contexts.
Problems in standardizing anthropometric surveys still exist (see Box 5.3) and can lead to difficulties in interpreting the results. Further problems may arise when generalized cut-offs for action (for example, a prevalence of more than 10% wasting and/or oedema) are employed in different settings, because appropriate local action must be based on more than just a single indicator. The relationship, between mortality, morbidity, and nutritional status differs in different settings. In other words, the risk of dying associated with acute undernutrition varies according to the local patterns of disease; it is also likely to vary according to age. More research is needed in this field in order to fully explain the significance of acute undernutrition in terms of risk of dying and other aspects of physical dysfunction in different settings.20
In the past two years an increasing number of anthropometric surveys have been conducted on adult and adolescent IDP and refugee groups by Concern, Action Contre la Faim (ACF), UNHCR, and the Centers for Disease Control and Prevention (CDC). The extremely high mortality rates among adults in emergencies in Ethiopia, Liberia, Somalia, and southern Sudan initially fuelled interest in the subject, as well as a consideration of the effects of adult mortality on the rest of the household. Only very limited scientific literature is available, however, on the diagnosis and treatment of undernourished adults.21, 22 In addition, the associations between the anthropometric cut-offs currently employed and mortality and morbidity are not well understood, or studied, in many population groups. These problems are compounded in adolescents because the growth spun starts at different ages depending on nutritional status, ethnicity, and possibly other environmental factors:
Famine Early Warning Systems and Food Security Assessments
Systems to warn of impending food crises are not new, although approaches to famine early warning have changed and developed considerably over the 1990s. Following the famines of the mid-1980s, a wide range of organizations became involved in famine early warning,d in the hope that better information systems could help prevent future famines.
d The OCHA “ReliefWeb” provides a list of early warning organizations, information, and related links (http://www.notes.relief-web.int/websites).
Early warning activities range from a global focus on national and international food availability, to a more localized focus on issues of access to food and food security. The Global Information and Early Warning System (GIEWS) run by the FAO from Rome monitors food supply and demand around the world, and its aim is to warn the international aid community and participating national governments of food shortages for food aid planning.23 The Famine Early Warning System (FEWS) of the U.S. Agency for International Development (USAID) publishes both regular regional bulletins and “special alerts.” These notices are based on vulnerability assessments that evaluate components of national and household food security in order to identify which people are food insecure, the nature of their problem, factors that could influence their food security, and possible interventions.
The regular joint FAO/WFP food and crop assessments undertaken to estimate national food aid needs, which are based on a “food balance sheet,” are an important part of GIEWS.24 In ongoing emergency refugee operations WFP and UNHCR periodically undertake joint food assessment missions (JFAMs). These missions make recommendations on number of beneficiaries, modalities of assistance, composition of the food basket, ration size, duration of assistance, and logistical arrangements. UNHCR normally provides the JFAM with a nutritionist and, if applicable, other specialists to help assess levels of economic self-reliance.
Activities with a more localized focus include regular food security monitoring systems and/or emergency food security assessments. Indicators monitored by such systems depend on the location but generally include market prices, a variety of coping strategies and migration, and sometimes anthropometric status. These systems were developed in the late 1980s and continue in most countries in the Horn and East Africa.25
In recent years NGOs have undertaken increasing numbers of ad hoc food security assessments of emergencies. The best known of these is the food economy approach of the Save the Children Fund, UK (SCF). This approach was developed in 1994 to more accurately assess food aid needs and allow more effective targetting of food aid in protracted emergencies. The approach has two main objectives: to understand how people survive and how patterns of survival have changed as a result of “shocks,” and second, to estimate the size of the food gap and thereby estimate food aid needs.26 The food economy approach has made a valuable contribution in highlighting the need for baseline data to interpret current events or food security indicators.
The Somalia Food Security Assessment Unit (FSAU) managed by WFP Somalia is a good example of combining various types of food security information systems. It uses the food economy approach to establish a baseline and monitors food security indicators and nutritional status over time to assess changes in food security. Where food security indicators cannot be monitored continuously, the FSAU relies on ad hoc missions, assessments, and sometimes surveys. FSAU collaborates with USAID FEWS to produce a joint newsletter, Rainwatch, issued every ten days during the main cropping season in Somalia. FEWS provides satellite data on rainfall estimates, cloud top temperatures, and the normalized difference vegetative index, while FSAU field monitors and other NGOs provide information collected locally on the ground.
Many NGOs contribute to the important field of assessing household food security, including SCF, ACF, Action Against Hunger (AAH), CARE, Oxfam, and Concern Worldwide.27 The International Committee of the Red Cross (ICRC) has developed its own method for assessing economic security. Although these agencies have similar concepts and definitions of food security, they have developed a range of approaches to assessing food security.27 This is partly because food security assessments may have different objectives, including the estimation of food aid needs, analysis of coping mechanisms, and the design of potential interventions. Thus the process of analysis and the style of the presentations vary. In all cases, however, the information is intended to help decision-makers form knowledgeable and timely decisions about the actions required to protect or improve the food security of an emergency-affected population.
Clinic admission data may also be useful as a type of early warning system and are currently used in many countries, including Burundi. These data must be carefully assessed by an experienced health worker who is aware of the country’s social and political climate in conjunction with other personnel working in sectors related to nutrition, for an increase in admissions could be due either to deterioration in the population’s nutritional status or to an increase in the ease of accessibility to clinics. In addition, such data may be biased by the geographical distribution of the clinics. As an early warning system and as a tool for evaluating and assessing current nutritional programmes, however, the data are useful. Clearly, the data are also useful when assessing whether or not a supplementary feeding programme needs to be re-orientated or closed down. The coordination of clinic admission data is crucial if meaningful comparisons between the nutritional situations over time and between regions are to be made - otherwise NGOs may have different reporting formats and action criteria.
[Ukrainian] [English] [Russian]