ENN update

Published:

21 March 2020

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Field Exchange

Special issue on wasting in South Asia

Asia is home to half of the world’s wasted children (25.9 million) and severely wasted children (8.6 million) and 40% of the world’s stunted children (58.7 million).¹ Over 80% of the estimated regional burden of wasting is concentrated in India alone. Uniquely, the prevalence and incidence of wasting in South Asia is often highest at birth and in the first months of life, then declines with age. The majority of wasting after the first year of life occurs among children who experienced wasting in early life. The wasting agenda is inadequately reflected in national health strategies and plans of South Asian countries and financial investments in the wasting agenda are insufficient to deliver services at scale.

There is a need to capture, collate and appraise learning and evidence from programming and research in South Asia to help build the evidence base to inform advocacy, priority actions and research agendas. As a contribution to this effort, Emergency Nutrition Network (ENN) and the United Nations Children’s Fund (UNICEF) Regional Office for South Asia (ROSA) have partnered to develop a special issue of Field Exchange on wasting in South Asia, to be published in September 2020.

The objective of this special issue is to increase understanding of the huge prevalence and burden of wasting in South Asia and document the current status, gaps, innovative approaches and opportunities in the policy and programme response. Priority content areas include: epidemiology of wasting in South Asia; implementation of models and packages in South Asia; interventions to reduce low birth weight; management of ‘at-risk’ mothers and infants under six months of age; integration of wasting programmes into health systems and health systems strengthening; experiences of implementing a continuum of care for wasted children; linking humanitarian and development programming to treat wasting; and implications of climate change on the burden of wasting in South Asia.

We are issuing an open call for content with a deadline for submission of 30 April 2020. Please send a short abstract (maximum 400 words) of your proposed article that explains how it will adderss a priority theme and key learning points to Chloe Angood at chloe@ennonline.net

Word from the FEX team about your subscription

Is your Field Exchange subscription up to date? Please check our website to make sure. If you are reading this as a non-subscriber, did you know that it is free to subscribe to Field Exchange directly? We will send you an email alert each time a new issue comes out. Print copies are also available free of charge for those who really need them. Manage your subscription at www.ennonline.net/subscribe/fex

Scaling up Nutrition Movement

ENN supported the Scaling Up Nutrition (SUN) Movement² Secretariat at the Global Gathering (GG)³ in November 2019 in Nepal, attended by 1,200 participants from over 100 countries. ENN conducted knowledge capture of the key outcomes of the 25 workshops that ran throughout the three-day gathering, feeding into both the SUN Global Gathering Report and a special SUN GG edition of ENN’s publication Nutrition Exchange described below.

ENN also published five briefing papers in time for the SUN GG 2019 to distil emerging themes of articles published in Field Exchange and Nutrition Exchange over the last five years. The syntheses of ENN learning examined over 150 relevant field-level articles and explored the key topics of:

1. Building an enabling environment

2. Utilising SUN mechanisms to catalyse scale-up

3. Scaling up nutrition-sensitive interventions

4. Scaling up nutrition-specific interventions

5. Working in fragile and conflict-affected states.

Download from www.ennonline.net/resources/sunscaleupnutsensitive

ENN also developed two country case studies exploring sub-national, multi-sector nutrition programming in the Philippines and Zimbabwe. These accompany six other case studies conducted in Senegal, Niger, Ethiopia, Kenya, Nepal and Bangladesh exploring the same theme. ENN now has a rich body of learning on multi-sector nutrition programming and will publish these reports alongside a synthesis paper in March. All of these materials can be downloaded from the SUN Knowledge Management section of ENN’s website at www.ennonline.net/ourwork/knowledgemanagement/sunkm

Nutrition Exchange

Look out for two Nutrition Exchange (NEX) publications coming out in 2020! End of March is the release date for NEX13, a special edition featuring country stories inspired by the SUN Movement 2019 Global Gathering. These articles capture key workshop themes from the conference, such as: innovative financing, data-driven decision-making, meeting the health and nutrition needs of adolescents, and how business and civil society can work together to improve nutrition – as told by the countries themselves.

In a second regional edition, NEX South Asia – to be released at the end of June – focuses on country efforts to improve young children’s diets. Stories range from the use of evidence to design a national infant and young child feeding strategy in Pakistan to the Government of Nepal’s experiences in implementing a social protection intervention (‘Child Grant’) and regional efforts to address increasing child overweight and obesity. New issues will be available on our website www.ennonline.net/nex or subscribe free of charge at www.ennonline.net/subscribe/nex

en-net

en-net is a free and open resource to help field practitioners have access to prompt technical advice for operational challenges for which answers are not readily accessible. Join en-net at www.en-net.org

Over the past six months, 50 questions have been posted on en-net, generating 157 responses. The forum area for Assessment and Surveillance generated most discussions, followed by the Prevention and management of severe acute malnutrition and Infant and young child feeding intervention areas. Fifty-two vacancy notices and announcements have been posted and have accumulated 24,526 views on the website.

A question was raised in the Assessment and Surveillance area as to whether KoBo Toolbox⁴ for mobile data collection can include a function for SMART survey teams to view a child’s z-score immediately during data collection to facilitate prompt referral of cases of severe acute malnutrition. Various technical workarounds were proposed and the United Nations High Commission for Refugees (UNHCR) shared that it is currently developing an algorithm of z-score calculation for incorporation into KoBo/Open Data Kit tool for its Standardised Expanded Nutrition Survey (SENS) methodology.⁵

A mobile app developed in the Philippines was shared,⁶ the main purpose of which is reporting violations of the Code of Marketing of Breastmilk Substitutes,⁷ although additional modules have been added, including one for growth monitoring. A growth monitoring chart intended for mothers to monitor their child’s growth has proven useful for health workers to detect and monitor stunting and wasting in their communities. The growth monitoring module is a simple calculator that can compute the child’s weight for height/length, weight for age and height/length for age. Users just enter the child’s birth date, weight in kg and height/length in cm. The app can be used offline.

The discussion evolved to consider the use of flags in survey data collection and analysis. Flagged entries during data collection should alert the team to immediately repeat the measurements and verify the age data of the child in question. While flags are meant to highlight ‘implausible’ values, implausibility does not mean impossibility and there are many reported instances of flagged cases being valid. Excluding them automatically can bias results.

In large surveys, such as Multiple Indicator Cluster Surveys (MICS) or Demographic Health Surveys (DHS), that collect data from many populations, each population may have different distributions of anthropometric indices and different prevalence of anthropometric indicators. In such cases the mean of the entire survey sample is unlikely to be a suitable reference mean and the assumed standard deviation (i.e., SD = 1) will usually be too narrow to set limits that define statistical outliers with the expected probabilities. This will lead to records being flagged incorrectly, likely leading to biased prevalence estimates.

It was proposed that it would be interesting to conduct an analysis of flagged data from multiple data sets and surveys to inform issues around the quality of evidence. The analysis could examine patterns in relation to the timing of measurements being taken, the survey team structure and composition or survey locale. Although participants in the discussion were aware that some analysis of these issues has been done, they were not aware of any systematic global studies.

To read more or join this discussion, go to www.en-net.org/question/3841.aspx

en-net has seen greater uptake by French-speaking users over the past few months, with an increasing number of posts from French-speaking countries in Africa. These include requests for the national protocol for the management of acute malnutrition in Cameroon (which was subsequently shared), discussion on Ebola virus disease, anthropometry and nutritional care in adults in the Democratic Republic of Congo (www.en-net.org/question/3846.aspx) and a question on thresholds for infant and young child feeding indicators from Cameroon (www.en-net.org/question/3873.aspx)

To join any discussion on en-net, share your experience or post a question, visit www.en-net.org.uk or www.fr.en-net.org

To feed back on the site, please write to post@en-net.org

Feed into ENN's evaluation and strategy

ENN is currently conducting an evaluation which will feed into the development of our new five year strategy (2021 – 2026). As key stakeholders of ENN, we would like to engage FEX readers in this process. We welcome your feedback on how we have done as an organisation over the last few years and your ideas for our future - this may relate to Field Exchange or to ENN’s activities more broadly. Email us with your thoughts.