Nutrition in emergencies: SCN conference 2003

Between 3-7 March, 2003 the annual United Nations SCN (Standing Committee on Nutrition) conference was held in Chennai, India. Key achievements and plans to emerge from the nutrition in emergencies working group, are summarised here¹

The main topic of the working group was experiences with, and research on, community based care of the severely malnourished as an alternative to therapeutic feeding centres. Four presentations were made:

• Update on the Community Therapeutic Care (CTC) programme-Steve Collins, Valid International
• Social and ethical issues related to CTC- Joseph-Matthew Mfutso-Bengo, University of Malawi & Valid International
• Experiences in CTC in North Sudan- Anna Taylor, Save the Children UK (SC UK)
• Protocol for Home Treatment: implementation of a clinical trial in Sierra Leone- Carlos Navarro-Colorado, Action Contre la Faim (ACF)

Published experiences of the CTC project in Ethiopia are summarised in this issue of Field Exchange, whilst experiences of SC UK in North Sudan have been previously included². Experiences from the clinical trial of home treatment by ACF, due to finish in July 2003, will be shared in a later issue of Field Exchange. A technical workshop, to clarify concepts and protocols in home-based treatment, is planned for October 2003 and will be reported in Field Exchange.

The working group also discussed the SMART (Standardised Monitoring and Assessment of Relief and Transitions) Project. This is an interagency initiative aimed at improving the monitoring, reporting and evaluation of humanitarian assistance, in order to ensure reliable data needed for making policy, funding and program decisions. A workshop, held in July 2002, produced a number of recommendations for assessing population stress:

Basic, essential indicators

Crude Mortality Rate (CMR) is the most significant public health indicator for all populations, particularly for societies in crisis, and should be included in anthropometric surveys.

Nutritional status of children under five is an essential indicator of the overall nutritional status of a population.

Sampling

Simple or systematic random sampling should be used where feasible, and the 30 x 30 cluster is recommended. All children in the sample household should be included, as well as households without children.

Reporting

A standardised reporting format should always be used, which includes all the information needed to evaluate the quality of the survey and demonstrate that the appropriate methodology has been used. Results should be provided in both Z score and percentage of the median. Findings should be interpreted in the context of the situation, including food security.

Plans over the next two years include development of the "SMART Manual for Dummies" on methodology on Crude Mortality Rate (CMR) and Nutritional Status and a pilot project to test the manual and it's implementation in Angola. More information is available on the SMART website: http://www.smartindicators.org/initiatives.htm

development in nutrition in emergencies, centred around an inventory of training courses in nutrition in emergencies, and a proposal to support training needs, based on an FAO assessment in Nairobi in 2001/2. Examples of training initiatives included:

• Tufts/WFP training: "Food and Nutrition in Emergencies"
• Tufts/Columbia/CDC: training of UNICEF Health and Nutrition officers: "Training for Improved Practice: Public health and Nutrition in Emergencies"
• SPHERE Project Health and Nutrition Training Plans for 2003-4 are to support training courses at the University of Nairobi (ANP), Affad University, Khartoum, Kabul University/Ministry of Health and 1-2 institutions in crisis affected countries. Plans also include strengthening links with other working groups, establishing contact with regional training focal points and sharing and dissemination of an inventory of training materials and strategy.

Training was also referred to in discussions on infant feeding in emergencies. Produced by a core group of agencies³, a training module 1: "Infant Feeding in Emergencies, for relief staff" has been distributed to emergency staff and is under evaluation. A second more technical module, "Infant feeding in Emergencies, for health workers" is nearing completion pending resolution of certain technical issues by the core group .

An update on the Sphere Project was reported by Anna Taylor SCF (UK). Evaluation of the use of the first version of the Sphere Project manual has been completed, and a revision process is under way. The revised Sphere standards document should be available in October, 2003. Saskia van Der Kam (MSF Holland) reported on the progress and plans for NutritionNET⁴, which is providing an active working environment for nutritionists, with a large African participation. Plans are to increase the involvement of experts in certain field related problems.

Finally, a call was made to revive the currently inactive adult malnutrition group. Relevant research plans outlined in discussions included research on anthropometric assessment in adults, and an exploration of approaches to dealing with adult malnutrition in the context of HIVAIDS.

¹Summary of the Nutrition in Emergencies Working Group, SCN, Chennai, March 2003. For further information, email: scn@who.int

²Field Exchange 16. Outpatient therapeutic programme (OTP). An evaluation of a new SC UK venture in North Darfur, Sudan (2001). p26

³A group of agency personnel, comprising UNICEF, UNHCR, WFP, WHO, IBFAN/GIFA, ENN and interested individuals, involved in developing and disseminating the material. See presentation summary in this issue of Field Exchange

⁴Field Exchange Issue 18. NutritionNet: independent nutrition information exchange, by Saskia van der Kam, p15